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Echocardiography to understand remodeling and to assess prognosis after acute myocardial infarction
1Cardiologia, A.R.C., Ospedale Civile, Pordenone, Italy.
Insights
Early lisinopril treatment effectively reduced left ventricular volume increase after myocardial infarction (MI). Predischarge echocardiography also identified patients at higher risk for mortality and heart failure post-MI.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Ventricular remodeling is a complex process following acute myocardial infarction (MI), involving structural and functional changes in the left ventricle.
- Limiting the initial myocardial insult, potentially through early reperfusion strategies like thrombolysis, is key to preventing or minimizing adverse remodeling.
- Echocardiography provides valuable prognostic information in post-MI patients.
Purpose of the Study:
- To evaluate the effect of lisinopril treatment on left ventricular remodeling after acute myocardial infarction.
- To assess the prognostic value of predischarge echocardiographic parameters in predicting outcomes after MI.
Main Methods:
- Analysis of 2D echocardiographic data from 6405 patients in the GISSI-3 trial.
- Patients received 6-week lisinopril treatment.
- Echocardiographic studies were performed at predischarge, 6 weeks, and 6 months post-infarction.
Main Results:
- Lisinopril treatment significantly reduced the increase in left ventricular volumes over time.
- Patients treated with lisinopril maintained smaller left ventricular volumes at 6 months, even after treatment withdrawal.
- Predischarge echocardiography revealed that larger left ventricular volumes and lower ejection fraction were associated with increased risk of mortality and heart failure within 6 months.
Conclusions:
- Early lisinopril treatment is effective in mitigating left ventricular remodeling post-MI.
- Predischarge echocardiography is a crucial tool for risk stratification in post-MI patients, identifying individuals at higher risk for adverse outcomes.
- These findings support the use of echocardiography for prognostic assessment and highlight the benefits of early pharmacological intervention in managing post-MI cardiac remodeling.
Abstract:
Ventricular remodeling indicates a dynamic process, starting with and after acute myocardial infarction, as a result of structural and functional modifications which involve acutely and chronically both the infarcted and noninfarcted zones of the left ventricle. The most effective way to prevent or minimize post-MI cardiac remodeling is to limit the extent of the initial insult. This can be partly achieved by early myocardial reperfusion obtained by different strategies including thrombolysis. In 6405 patients of the GISSI-3 trial, 2D echocardiographic studies were available at predischarge, at 6 weeks and at 6 months after the infarction. The increase in left ventricular volumes over time was reduced by 6-week lisinopril treatment. Patients randomized to lisinopril had smaller volume also at 6 months, after withdrawal of treatment at 6 weeks. Important prognostic indications can also be derived from predischarge echocardiography, since larger quartiles of left ventricular volumes and lower quartile of ejection fraction indicates higher risk of mortality and non-fatal congestive heart failure in the 6 months after the index event, even in the relatively low risk general population of infarcts of the GISSI-3.