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Published on: December 2, 2014
Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance
João C Silva1, Carlos E Rochitte, José S Júnior
1Acute Coronary Disease Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Enéas de Carvalho de Aguiar, 44, 2nd Floor, 05403-000, São Paulo, Brazil. joaoclima@uol.com.br
Insights
Late recanalization after myocardial infarction (MI) improved left ventricular ejection fraction and contractility. This intervention did not alter ventricular volumes but may enhance long-term outcomes for patients with sustained infarct-related artery patency.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Left ventricular (LV) remodelling and impaired contractility are significant complications following myocardial infarction (MI).
- The impact of late recanalization on these post-MI sequelae compared to conservative management remains an area of investigation.
Purpose of the Study:
- To evaluate the effects of late recanalization on left ventricular (LV) remodelling and contractility in patients post-myocardial infarction (MI).
- To compare these effects against conservative therapy in patients with an occluded infarct-related artery.
Main Methods:
- Thirty-six patients with occluded infarct-related artery post-anterior MI were randomized to percutaneous coronary intervention (PCI) or conservative therapy.
- Magnetic resonance imaging (MRI) assessed LV parameters at baseline and 6 months, analyzing infarct, adjacent, and remote segments.
Main Results:
- No significant difference in LV volumes between PCI and no-PCI groups at 6-month follow-up.
- The PCI group showed a significant improvement in LV ejection fraction (5.00% vs. -0.76%, P=0.012).
- Improved circumferential shortening in remote segments was observed in the PCI group compared to the no-PCI group (P<0.001).
Conclusions:
- Late recanalization positively impacts LV ejection fraction and myocardial contractility in the late phase post-MI.
- Sustained patency of the infarct-related artery through recanalization may lead to improved global and regional LV contractility, potentially benefiting long-term outcomes.
Aims:
To assess the recanalization effects of post-myocardial infarction (MI) on left ventricular (LV) remodelling and contractility in relation to conservative therapy.
Methods And Results:
Thirty-six patients with occluded infarct-related artery between 12 h and 14 days post-anterior MI were randomized to percutaneous coronary intervention (PCI group) or conservative therapy (no-PCI group). Magnetic resonance imaging was performed at enrollment and after 6 months. The left ventricle was divided into infarct, adjacent, and remote segments. There was no difference in relation to LV volume between groups at the 6 month follow-up. Change in LV ejection fraction was favourable to the PCI group: 5.00% vs. -0.76%, P=0.012. Change in circumferential shortening (Ecc) of the remote segments in the PCI group was significantly better than in the no-PCI group: -1.67+/-6.30% vs. 0.29+/-6.02%, P<0.001. Infarct size and LV mass were similar between groups.
Conclusions:
Late recanalization improved LV ejection fraction and myocardial contractility in late follow-up, but did not change the ventricular volumes. Improvement in the left ventricle global and regional contractility may benefit the long-term outcome in post-MI patients with sustained patency of the infarct-related artery.
