RT Journal Article
SR Electronic
T1 Reversible microvascular dysfunction coupled with persistent myocardial dysfunction: implications for post-infarct left ventricular remodelling
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 565
OP 571
DO 10.1136/hrt.2006.091538
VO 93
IS 5
A1 Leonarda Galiuto
A1 Francesca A Gabrielli
A1 Antonella Lombardo
A1 Giuseppe La Torre
A1 Antonio Scarà
A1 Antonio G Rebuzzi
A1 Filippo Crea
YR 2007
UL http://heart.bmj.com/content/93/5/565.abstract
AB 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.