Prevalence and predictors of ventricular remodeling after anterior myocardial infarction in the era of modern medical therapy

Elaine Farah, Ana Lucia Cogni, Marcos F Minicucci, Paula S Azevedo, Katashi Okoshi, Beatriz B Matsubara, Silméia G Zanati, Rodrigo Haggeman, Sergio A R Paiva, Leonardo A M Zornoff, Elaine Farah, Ana Lucia Cogni, Marcos F Minicucci, Paula S Azevedo, Katashi Okoshi, Beatriz B Matsubara, Silméia G Zanati, Rodrigo Haggeman, Sergio A R Paiva, Leonardo A M Zornoff

Abstract

Background: The consequences of aggressive therapy following a myocardial infarction (MI) on ventricular remodeling are not well established. Thus, the objective of this study was to analyze the prevalence, clinical characteristics, and predictors of left ventricular remodeling in the era of modern medical therapy.

Material/methods: Clinical characteristics and echocardiographic data were analyzed in 66 consecutive patients with anterior infarction at admission and at 6-month follow-up. Ventricular remodeling was defined as an increase of 10% in ventricular end-systolic or end-diastolic diameter.

Results: In our study, 58% of patients presented with ventricular remodeling. Patients with remodeling possessed higher total plasma creatine kinase (CPK), MB-fraction (CPK-MB), heart rate, heart failure, shortness of breath, and reperfusion therapy than patients without remodeling. In contrast, patients with remodeling had a smaller ejection fraction, E-Wave deceleration time (EDT), and early (E' Wave) and late (A' Wave) diastolic mitral annulus velocity (average of septal and lateral walls), but a higher E/E' than patients without remodeling. Patients with remodeling used more diuretics, digoxin, oral anticoagulants and aldosterone antagonists than patients without remodeling. In the multivariate analyses, only E' Wave was an independent predictor of ventricular remodeling. Each 1 unit increase in the E' Wave was associated with a 59% increased odds of ventricular remodeling.

Conclusions: In patients with anterior MI, despite contemporary treatment, ventricular remodeling is still a common event. In addition, diastolic function can have an important role as a predictor of remodeling in this scenario.

Figures

Figure 1
Figure 1
ROC curve for ventricular remodeling. Cutoff ≤9; sensitivity=67.6%; specificity=89.3% (AUC=0.822; 95% CI=0.708–0.906; p=0.0001).

References

    1. Duarte DR, Minicucci MF, Azevedo PS, et al. Influence of lisinopril on cardiac remodeling induced by tobacco smoke exposure. Med Sci Monit. 2010;16(8):BR255–59.
    1. Oliveira SA, Junior, Dal Pai-Silva M, Martinez PF, et al. Diet-induced obesity causes metabolic, endocrine and cardiac alterations in spontaneously hypertensive rats. Med Sci Monit. 2010;16(12):BR367–73.
    1. Oliveira SA, Junior, Dal Pai-Silva M, Martinez PF, et al. Differential nutritional, endocrine, and cardiovascular effects in obesity-prone and obesity-resistant rats fed standard and hypercaloric diets. Med Sci Monit. 2010;16(7):BR208–17.
    1. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol. 2000;35:569–82.
    1. Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction: experimental observations and clinical implications. Circulation. 1990;81:1161–72.
    1. Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation. 1993;87:755–63.
    1. Zornoff LAM, Paiva SAR, Duarte DR, Sparado J. Ventricular remodeling after myocardial infarction: concepts and clinical implications. Arq Bras Cardiol. 2009;92:157–64.
    1. Bolognese L, Cerisano G. Early predictors of left ventricular remodeling after acute myocardial infarction. Am Heart J. 1999;138:S79–83.
    1. Savoye C, Equine O, Tricot O, et al. Left ventricular after anterior wall acute myocardial infarction in modern clinical practice. Am J Cardiol. 2006;98:1144–49.
    1. Kushner FG, Hand M, Smith SC, Jr, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120:2271–306.
    1. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003;349:1893–906.
    1. Lang RM, Bierig M, Devereaux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.
    1. Merlo M, Pyxaras SA, Pinamonti B, et al. Prevalence and prognostic significance of left ventricular reverse remodeling in dilated cardiomyopathy receiving tailored medical treatment. J Am Coll Cardiol. 2011;57:1468–76.
    1. Eaton LW, Bulkley BH. Expansion of acute myocardial infarction: its relationship to infarct morphology in a canine model. Circ Res. 1981;49:80–88.
    1. Hochman LS, Bulkley BH. Expansion of acute myocardial infarction: an experimental study. Circulation. 1982;65:1446–50.
    1. Schuster EH, Bulkley BH. Expansion of transmural myocardial infarction: a pathophysiologic factor in cardiac rupture. Circulation. 1979;60:1532–38.
    1. Pirolo JS, Hutchins GM, Moore GW. Infarct expansion. Pathologic analysis of 204 patients with a single myocardial infarct. J Am Coll Cardiol. 1986;7:349–54.
    1. Jeremy RW, Hackworthy RA, Bautovich G, et al. Infarct artery perfusion and changes in left ventricular volume in the month after acute myocardial infarction. J Am Coll Cardiol. 1987;9:989–95.
    1. Jeremy RW, Allman KC, Bautovitch G, Harris PJ. Patterns of left ventricular dilation during the six months after myocardial infarction. J Am Coll Cardiol. 1989;13:304–10.
    1. Solomon SD, Pfeffer MA. The decreasing incidence of left ventricular remodeling following myocardial infarction. Basic Res Cardiol. 1997;92:61–65.
    1. Pfeffer MA, Lamas GA, Vaughan DE, et al. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med. 1988;319:80–86.
    1. Senior R, Basu S, Kinsey C, et al. Carvedilol prevents remodeling in patients with left ventricular dysfunction after after acute myocardial infarction. Am Heart J. 1999;137:646–52.
    1. Bellenger NG, Swinburn JMA, Rajappan K, et al. Cardiac remodeling in the era of aggressive medical therapy: does it still exist? Int J Cardiol. 2002;83:217–25.
    1. Loboz-Grudzien K, Kowalska A, Brzezinska B, et al. Early predictors of adverse left ventricular remodelling after myocardial infarction treated by primary angioplasty. Cardiol J. 2007;14:238–425.
    1. Garcia-Alvarez A, Sitges M, Delgado V, et al. Relation of plasma brain natriuretic peptide levels on admission for ST-elevation myocardial infarction to left ventricular end-diastolic volume six months later measured by both echocardiography and cardiac magnetic resonance. Am J Cardiol. 2009;104:878–82.
    1. Carrabba N, Parodi G, Valenti R, et al. Comparison of effects of primary coronary angioplasty on left ventricular remodeling and heart failure in patients <70 versus > or =70 years with acute myocardial infarction. Am J Cardiol. 2009;104:926–31.
    1. Meta-Analysis Research Group in Echocardiography (MeRGE) AMI Collaborators. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation. 2008;117:2591–98.
    1. Pfeffer MA, Greaves SC, Arnold JMO, et al. Early versus delayed angiotensin converting enzyme inhibition therapy in acute myocardial infarction: In the Healing and Early Afterload Reducing Therapy Trial. Circulation. 1997;95:2643–51.

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