CARDIOVASCULAR MEDICINE

Impact of microvascular integrity and local viability on left ventricular remodelling after reperfused acute myocardial infarction

P Garot, O Pascal, M Simon, J L Monin, E Teiger, J Garot, P Guéret, J L Dubois-Randé

Fédération de Cardiologie, Hôpital Henri Mondor, Créteil, France

Correspondence to:
Correspondence to:
Dr P Garot, Fédération de Cardiologie, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
philippe.garot{at}hmn.ap-hop-paris.fr

Objective: To assess left ventricular remodelling in patients with reperfused acute myocardial infarction and to study its relation to microvascular damage.

Patients: 25 patients successfully treated by primary percutaneous coronary angioplasty for acute myocardial infarction.

Setting: University hospital

Methods: Indexed end diastolic (EDVi) and end systolic (ESVi) volumes were assessed on admission and repeated at days 1 and 8. Coronary flow reserve (CFR) was assessed in the infarct related artery on day 1. Myocardial blood volume was assessed on admission and at day 8 by myocardial contrast echocardiography. In patients who manifested persistent myocardial dysfunction at hospital discharge (n = 21), local inotropic reserve was assessed by dobutamine echocardiography at day 7.

Results: On admission, patients with and without local viability had similar EDVi and ESVi (EDVi 67 (9) and 73 (14) ml/m², respectively; ESVi 34 (8) and 40 (11) ml/m², respectively; NS). EDVi increased to 97 (22) ml/m² in patients without local viability (p < 0.01 v admission) but remained unchanged at 70 (11) ml/m² in patients with viable myocardium (NS v admission). For pooled patient data, the percentage change in EDVi correlated with CFR (r = 0.76, p < 0.0001) and myocardial blood volume in the infarct territory (r = 0.80, p < 0.0001).

Conclusion: Left ventricular dilatation may preferably occur in patients without local viability and is correlated with early CFR and extent of myocardial blood volume in the infarct territory.

Keywords: remodelling; acute myocardial infarction; reperfusion injury; reserve

Abbreviations: CFR, coronary flow reserve; CFR_IRA, coronary flow reserve in the infarct related artery; EDVi, indexed end diastolic volume; ESVi, indexed end systolic volume; TIMI, thrombolysis in myocardial infarction

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