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Reversible microvascular dysfunction coupled with persistent myocardial dysfunction: implications for post-infarct left ventricular remodelling
  1. Leonarda Galiuto1,
  2. Francesca A Gabrielli1,
  3. Antonella Lombardo1,
  4. Giuseppe La Torre2,
  5. Antonio Scarà1,
  6. Antonio G Rebuzzi1,
  7. Filippo Crea1
  1. 1Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
  2. 2Epidemiology and Biostatistics Unit, Institute of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to:
    Dr L Galiuto
    Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A Gemelli, Largo A Gemelli, 8, 00168 Rome, Italy; lgaliuto{at}rm.unicatt.it

Abstract

Background: Recent studies have shown that microvascular dysfunction after myocardial infarction is a dynamic phenomenon.

Aims: To evaluate the implications of dynamic changes in microvascular dysfunction on contractile recovery and left ventricular remodelling, and to identify the ideal timing of assessment of such microvascular dysfunction.

Methods and results: In 39 patients with a first myocardial infarction who underwent successful percutaneous coronary intervention, microvascular dysfunction was studied by myocardial contrast echocardiography (MCE) at 24 h, 1 week and 3 months after the procedure. Real-time MCE was performed by contrast pulse sequencing and intravenous Sonovue. 14 patients exhibited left ventricular remodelling at 3 months (>20% increase in left ventricular end-diastolic volume, group B), whereas 25 did not (group A). Microvascular dysfunction was similar in the two groups at 24 h and improved in group A only, being significantly better than that of group B at 1 week (p<0.05) and 3 months (p<0.005). Improvement in microvascular dysfunction was not associated with improvement in wall motion in the same segments. With multivariate analysis including all echocardiographic variables, microvascular dysfunction at 1 week was found to be the only independent predictor of left ventricular remodelling (p<0.01). With a cut-off value of 1.4, 1-week microvascular dysfunction predicts left ventricular remodelling with sensitivity and specificity of 73%.

Conclusions: Improvement in microvascular dysfunction occurs early after myocardial infarction, although it is not associated with a parallel improvement in wall motion but is beneficial in preventing left ventricular remodelling. Accordingly, 1-week microvascular dysfunction is a powerful and independent predictor of left ventricular remodelling.

  • EDV, end-diastolic volume
  • MCE, myocardial contrast echocardiography
  • MCESI, myocardial contrast echocardiography score index
  • PCI, percutaneous coronary intervention
  • TIMI, thrombolysis in myocardial infarction
  • WMS, wall motion score
  • WMSI, wall motion score index

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Footnotes

  • Published Online First 15 September 2006

  • Competing interests: None.

  • Informed consent was obtained for publication of the patients’ details in this report.

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