Imaging and Diagnostic TestingHeterogeneity of left ventricular remodeling after acute myocardial infarction: Results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-3 Echo Substudy☆,☆☆,★
Section snippets
Methods
The GISSI-3 Echo substudy initially evaluated 878 patients, as a subset coming from 47 coronary care units, among the 19,394 patients randomized within the GISSI-3 trial.9 Patients were initially considered eligible if they had confirmed AMI as previously reported9 and echocardiogram recordings suitable for qualitative and quantitative analysis. The protocol required serial standard electrocardiographic and echocardiographic studies at 24 to 48 hours (S1) (mean 36 ± 8 hours) from symptom onset,
Results
Patients with reinfarction (n = 23, 2.6%), percutaneous transluminal coronary angioplasty, or coronary artery by-pass surgery (n = 75, 8.5%) during the 6-month period of the study and those with incomplete echocardiographic follow-up or echocardiographic images insufficient for quantitative analysis (n = 130, 15%) were excluded from analysis. Thirty-six patients died during the follow-up. The remaining 614 patients (mean age 61 ± 12 years) who underwent all four echocardiographic examinations
Discussion
This study, in a large series of consecutive AMI patients intensively exposed to recommended treatments, survivors at 6-month follow-up without adverse events, demonstrates that LV remodeling after infarction occurs despite spontaneous recovery of regional dysfunction and is particularly evident in larger infarcts. However, early in-hospital ventricular enlargement is not predictive of subsequent dilation and systolic dysfunction. In contrast, late remodeling is associated with progressive
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Endorsed by the Associazione Nazionale Medici Cardiologi Ospedalieri and the Istituto di Ricerche Farmacologiche “Mario Negri,” Milan, Italy, and supported in part by grants from Zeneca, Italy, Schwarz-Pharma, Italy, and the Cardiovascular Research Foundation, Bad Schwalbach, Germany.
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Investigators and institutions participating in the GISSI-3 Echo Substudy are listed in the Appendix.
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Reprint requests: Pantaleo Giannuzzi, MD, Fondazione “Salvatore Maugeri,” IRCCS, Via Revislate, 13, 28010 Veruno (NO), Italy. E-mail: [email protected]