J Korean Soc Echocardiogr.  1995 Jul;3(1):1-9. 10.4250/jkse.1995.3.1.1.

Relation Between Residual Stenosis of Infarct-related Artery and Left Ventricular Dilatation After Acute Myocardial Infarction

• Lim DS
• Shim WJ
• Park SW
• Park CG
• Kim YH
• Seo HS
• Oh DJ
• Ro YM

• KMID: 2410425
• DOI: http://doi.org/10.4250/jkse.1995.3.1.1

Abstract

BACKGROUND
Acute myocardial infarction produces alteration in the topography of both infarcted and non-infarcted region of ventricle. This remodelling process is reported to be influenced by several factors, such as infarct size, ventricular wall stress and patency of infarct-related artery. But little is known about the residual stenosis and its relation to ACE inhibitor in the change of left ventricular volume over time. METHOD: To investigate the relation between clinical and angiographic factors, especially degree of residual stenosis, and ventricular dilatation after acute myocardial infarction, echocardiography was done twice(7-15 days, 1 year) in 19 patients(male 11, female 8, mean age=56±10 yrs) of first acute anterior myocardial infarction with patent infarct-related artery. Measurement of left ventricular volume and ejection fraction was done by modified Simpson's method in apical four chamber view and left ventricle was divided into 16 segments and was analysed by 4 degree scoring method. The change of left ventricular volume and function was compared with clinical factors and angiographic findings.
RESULTS
1) There was no correlation between dilatation of left ventricle after acute myocardial infarction and history of hypertension or diabetes mellitus, use of thrombolytic agent in patients with patent infarct related coronary artery. 2) The increase of left ventricular volume after acute myocardial infarction was seen only in the group with more than 70% residual left anterior descending stenosis.(8.8% increase in group with >70% residual stenosis, 4.4% decrease in group with < 70% residual stenosis, p=0.02). 3) The effect of ACE infibitor in preventing left venticular dilatation after acute myocardial infarction was observed with marginal statistical significance in patients with more than 70% residual stenosis of infarct-related artery only(P=0.06, r=0.542).
CONCLUSION
After myocardial infarction, the dilatation of left ventricular was more frequently observed in patients with more than 70% resideual stenosis of infarct-related artery. The beneficial effect of ACE infibitor in prevention of left ventricular dilatation was seen only in this group.

Keyword

Remodeling; Myocardial Infarction

MeSH Terms

Arteries*
Constriction, Pathologic*
Coronary Vessels
Diabetes Mellitus
Dilatation*
Echocardiography
Female
Heart Ventricles
Humans
Hypertension
Methods
Myocardial Infarction*
Research Design

Figure

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  Fig. 1. % Change of left ventricle volume according to residual stenosis of LAD.

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  Fig. 2. Change of left ventricular volume according to ACE inhibitor in >70% residual stenosis of LAD.

Reference

References

1). Kostuk WJ, Kozamias TM, Gander MP, Simon AL, Ross J. Left ventricular size after acute myocardial infarction. Circulation. XLVII:1174. 1973.

2). Pierard LA, Albert A, Gilis F, Sprynger M, Carlier J, Kulbertus HE. Hemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion. Am J Cardiol. 60:5. 1987.

3). Picard MH, Wilkins GT, Ray PA, Weyman AC. Natural history of left ventricular size and function after acute myocardial infarction. Circulation. 82:484. 1990.

4). Gadsboll N, Hoilund-Carlzen PF, Badsberg JH, Stage P, Marving J, Lonborg-Jensen H, Jensen BH. Late ventricular dilatation in survivors of acute myocardial infarction. Am J Cardiol. 64:961. 1989.

5). 심완주 • 안태훈 • 김영훈 • 노영무. 급성 심근경색 후 좌심실 기능과 용적의 변화에 대한 연구, 대한 내과학회 잡지. 41:749. 1991.

6). Pfeffer MA, Lamas GA, Vaughan DE, Parisi AF, Braunwald E. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med. 319:80. 1988.

7). Pfeffer JM, Pfeffer MA, Braunwald E. Influence of chronic captopril therapy on the infarcted left ventricle of the rat. Cir Res. 57:84. 1985.

8). Fletcher PJ, Pfeffer JM, Pfeffer MA, Braunwald E. Left ventricular diastolic pressure-volume relations in rats with healed myocardial infarction. Circ Res. 49:618. 1981.

9). Hori M, Inoue M, Mishima M, Shimazu T, Abe H, Fukui S. Infarct size and left ventricular ejection fraction in acute myocardial infarction. Jpn Circ J. 41:1299. 1977.

10). Ross J Jr, McCullagh WH. Nature of enhanced performance of the dilated left ventricle in the dog during chronic volume overloading. Circ Res. 30:549. 1972.

11). Pfeffer MA, Pfeffer JM, Fishbein MC, Fletcher PJ, Spadaro J, Kolner RA, Braunwald E. Myocardial infarct size and ventricular function in rats. Cir Res. 44:503. 1979.

12). Pfeffer MA, Pfeffer JM, Steinberg C, Finn P. Survival after an experimental myocardial infarction: Beneficial effects on longterm therapy with captopril. Circulation. 72:406. 1985.

13). Shanoff HM, Little JA, Csima A, Yano R. Heart size and ten-year survival after uncomplicated myocardial infarction. Am Heart J. 78:608. 1969.

14). Marino P, Zanolla L, Zardini P. GI-SSI. Effect of streptokinase on left ventricular modelling and function after myocardial infarction: The GISSI (Group Italiano per lostudio della Streptochinaisi nell'Infarto Miocardico) Trial. J Am Coll Cardiol. 14:1149. 1989.

15). Serruys PW, Simoons ML, Suryapranata H, Vermeer F, Wijns W, van den Brand M, Bar F, Zwaan Cm Krauss XH, Remme WJ, Res J, Verheugh FWA, van Domburg R, Lubsen J, Hugenholtz PG. For the Working Group on Thrombolytic Therapy in Acute Myocardial Infarction of the Netherlands Interuniversity Cardiology Institute: Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 7:726. 1986.

16). Jeremt RW, Hackwarthy RA, Bautovich G, Hutton BF, Harris PJ. Infarct artery perfusion and changes in left ventricular volume in the month after acute myocardial infarction. J Am Coll Cardiol. 9:989. 1987.

17). Schroder R, Neuhaus KL, Lomderer T, Bruggemann T, Tebbe U, Wegscheider K. Impact of late coronary artery reperfusion on left ventricular function one month after myocardial infarction: Results from the ISAM study. Am J Cardiol. 64:878. 1989.

18). Cigarroa RG, Lange RA, Hillis LD. Prognosis after acute myocardial infarction in patients with and without residual anterograde coronary blood flow. Am J Cardiol. 64:155. 1989.

19). Lamas GA, Baughan DE, Parisi AF, Pfeffer MA. Effects of left ventricular shape and captopril therapy on exercise capacity after anterior wall acute myocardial infarction. Am J Cardiol. 63:1167. 1989.

20). Bonaduce D, Petretta M, Morgano G, Villari B, Bianchi V, Conforti G, Salemme L, Themistoclakis S, Pulcino A. Left ventricular remodelling in the year after myocardial infarction: An echocardiographic haemodynamic, and radionuclide angiographic study. Coron-Artery-Dis. 5:155. 1994.

21). Leung WH, Lau CP. Effects of severity of the residual stenosis of the infarct-related coronary artery on left ventricular dilation and function after acute myocardial infarction. J Am Coll Cardiol. 20:307. 1992.

22). Tobis J, Sato D, Nalcioglu O, et al. Correlation of minimum coronary lumen diameter with left ventricular functional impairment induced by atrial pacing. Am J Cardiol. 61:697. 1988.