Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study
Aims Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treate...
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| Veröffentlicht in: | European heart journal 2009-03, Vol.30 (5), p.566-575 |
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| creator | Funaro, Stefania La Torre, Giuseppe Madonna, Mariapina Galiuto, Leonarda Scarà, Antonio Labbadia, Alessandra Canali, Emanuele Mattatelli, Antonella Fedele, Francesco Alessandrini, Francesco Crea, Filippo Agati, Luciano |
| description | Aims Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated. Methods and results Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05). Conclusion r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR. |
| doi_str_mv | 10.1093/eurheartj/ehn529 |
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We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated. Methods and results Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05). Conclusion r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehn529</identifier><identifier>PMID: 19098019</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Acute myocardial infarction ; Aged ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular system ; Clinical Research ; Contrast Media ; Coronary heart disease ; Diseases of the cardiovascular system ; Echocardiography - methods ; Epidemiologic Methods ; Female ; Heart ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Myocardial contrast echocardiography ; Myocardial Infarction - diagnostic imaging ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocarditis. Cardiomyopathies ; Observer Variation ; Phospholipids ; Prognosis ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Sulfur Hexafluoride ; Ultrasonic investigative techniques ; Ventricular Remodeling</subject><ispartof>European heart journal, 2009-03, Vol.30 (5), p.566-575</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org 2009</rights><rights>2009 INIST-CNRS</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-d77de9e06db3c97434b2df4a4666fea4a7666ed96ad4831e2e72931a8a131ea83</citedby><cites>FETCH-LOGICAL-c525t-d77de9e06db3c97434b2df4a4666fea4a7666ed96ad4831e2e72931a8a131ea83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,1579,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21257834$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19098019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Funaro, Stefania</creatorcontrib><creatorcontrib>La Torre, Giuseppe</creatorcontrib><creatorcontrib>Madonna, Mariapina</creatorcontrib><creatorcontrib>Galiuto, Leonarda</creatorcontrib><creatorcontrib>Scarà, Antonio</creatorcontrib><creatorcontrib>Labbadia, Alessandra</creatorcontrib><creatorcontrib>Canali, Emanuele</creatorcontrib><creatorcontrib>Mattatelli, Antonella</creatorcontrib><creatorcontrib>Fedele, Francesco</creatorcontrib><creatorcontrib>Alessandrini, Francesco</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Agati, Luciano</creatorcontrib><creatorcontrib>AMICI Investigators</creatorcontrib><creatorcontrib>on behalf of AMICI Investigators</creatorcontrib><title>Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated. Methods and results Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05). Conclusion r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.</description><subject>Acute myocardial infarction</subject><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Clinical Research</subject><subject>Contrast Media</subject><subject>Coronary heart disease</subject><subject>Diseases of the cardiovascular system</subject><subject>Echocardiography - methods</subject><subject>Epidemiologic Methods</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial contrast echocardiography</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Observer Variation</subject><subject>Phospholipids</subject><subject>Prognosis</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Sulfur Hexafluoride</subject><subject>Ultrasonic investigative techniques</subject><subject>Ventricular Remodeling</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkk-P0zAQxSMEYpeFOydkIYFAbNnYSZyEA1KpgK20KwQCVHGxpvakdTexi-1U9MPyXXCUqvw5cUri-b03M85Lkoc0fUnTOrvA3q0RXNhc4NoUrL6VnNKCsUnN8-J2cprSuphwXi1Oknveb9I0rTjld5MTWqd1Faunyc-5kVqhkXhOFAZ0nTZggj8nYBTZOrsy1gctyQ7aHoltiMMdOo-kxSaQHZrgtOxbcLHQWYVtq82KQBOtolx34PZki072AQza3hNpnTXDqTaRGQy0Na-i2vdt8EOHsEYyjQIk13srwSkNLZmbBpwcWDKzsSn4QOYdrIZuz6bX89n8Oemig5Y4-BIferW_n9xpoPX44PA8S768e_t5djm5-vB-PpteTWTBijBRZamwxpSrZSbrMs_yJVNNDjnnvEHIoYwvqGoOKq8yigxLVmcUKqDxC6rsLHk9-m77ZYdqGMFBKw77Cwta_F0xei1WdicYz2tWZdHg6cHA2e89-iA67WW8zPHSBOdxrPjvIvj4H3Bje2ficoLRIo9UNUDpCElnvXfYHCehqRiCI47BEWNwouTRnxv8FhySEoEnBwC8hLZxEIPjjxyjrCirLI_ci5Gz_fZ_2k5GWvuAP448uBvBy6wsxOXim_j05mP5dUFzwbJf8L31yw</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>Funaro, Stefania</creator><creator>La Torre, Giuseppe</creator><creator>Madonna, Mariapina</creator><creator>Galiuto, Leonarda</creator><creator>Scarà, Antonio</creator><creator>Labbadia, Alessandra</creator><creator>Canali, Emanuele</creator><creator>Mattatelli, Antonella</creator><creator>Fedele, Francesco</creator><creator>Alessandrini, Francesco</creator><creator>Crea, Filippo</creator><creator>Agati, Luciano</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090301</creationdate><title>Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study</title><author>Funaro, Stefania ; La Torre, Giuseppe ; Madonna, Mariapina ; Galiuto, Leonarda ; Scarà, Antonio ; Labbadia, Alessandra ; Canali, Emanuele ; Mattatelli, Antonella ; Fedele, Francesco ; Alessandrini, Francesco ; Crea, Filippo ; Agati, Luciano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-d77de9e06db3c97434b2df4a4666fea4a7666ed96ad4831e2e72931a8a131ea83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute myocardial infarction</topic><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Clinical Research</topic><topic>Contrast Media</topic><topic>Coronary heart disease</topic><topic>Diseases of the cardiovascular system</topic><topic>Echocardiography - methods</topic><topic>Epidemiologic Methods</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial contrast echocardiography</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Observer Variation</topic><topic>Phospholipids</topic><topic>Prognosis</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Sulfur Hexafluoride</topic><topic>Ultrasonic investigative techniques</topic><topic>Ventricular Remodeling</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Funaro, Stefania</creatorcontrib><creatorcontrib>La Torre, Giuseppe</creatorcontrib><creatorcontrib>Madonna, Mariapina</creatorcontrib><creatorcontrib>Galiuto, Leonarda</creatorcontrib><creatorcontrib>Scarà, Antonio</creatorcontrib><creatorcontrib>Labbadia, Alessandra</creatorcontrib><creatorcontrib>Canali, Emanuele</creatorcontrib><creatorcontrib>Mattatelli, Antonella</creatorcontrib><creatorcontrib>Fedele, Francesco</creatorcontrib><creatorcontrib>Alessandrini, Francesco</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Agati, Luciano</creatorcontrib><creatorcontrib>AMICI Investigators</creatorcontrib><creatorcontrib>on behalf of AMICI Investigators</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Funaro, Stefania</au><au>La Torre, Giuseppe</au><au>Madonna, Mariapina</au><au>Galiuto, Leonarda</au><au>Scarà, Antonio</au><au>Labbadia, Alessandra</au><au>Canali, Emanuele</au><au>Mattatelli, Antonella</au><au>Fedele, Francesco</au><au>Alessandrini, Francesco</au><au>Crea, Filippo</au><au>Agati, Luciano</au><aucorp>AMICI Investigators</aucorp><aucorp>on behalf of AMICI Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>30</volume><issue>5</issue><spage>566</spage><epage>575</epage><pages>566-575</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims Few data are available on the extent and prognostic value of reverse left ventricular remodelling (r-LVR) after ST-elevation acute myocardial infarction (STEMI). We sought to evaluate incidence, major determinants, and long-term clinical significance of r-LVR in a group of STEMI patients treated with primary percutaneous coronary intervention (PPCI). In particular, the role of preserved microvascular flow within the infarct zone in inducing r-LVR has been investigated. Methods and results Serial echocardiograms (2DE) and myocardial contrast study were obtained within 24 h of coronary recanalization (T1) and at pre-discharge (T2) in 110 reperfused STEMI patients. Follow-up 2DE was scheduled after 6 months (T3). Two-year clinical follow-up was obtained. Reverse remodelling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 months follow-up. r-LVR occurred in 39% of study population. At multivariable analysis, independent predictors of r-LVR were an effective microvascular reflow within the infarct zone, the in-hospital improvement of myocardial perfusion, an initial large LVESV, and a short time to reperfusion. Cox analysis identified r-LVR as the only independent predictor of 2-year event-free survival. Combined events rate was significantly higher among patients without compared to those with r-LVR (log-rank test P < 0.05). Conclusion r-LVR frequently occurs in STEMI patients treated with PPCI and it is an important predictor of favourable long-term outcome. A preserved microvascular perfusion within the infarct zone is the major determinant of r-LVR.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>19098019</pmid><doi>10.1093/eurheartj/ehn529</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute myocardial infarction Aged Angioplasty, Balloon, Coronary Biological and medical sciences Cardiology. Vascular system Cardiovascular system Clinical Research Contrast Media Coronary heart disease Diseases of the cardiovascular system Echocardiography - methods Epidemiologic Methods Female Heart Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Myocardial contrast echocardiography Myocardial Infarction - diagnostic imaging Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocarditis. Cardiomyopathies Observer Variation Phospholipids Prognosis Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Sulfur Hexafluoride Ultrasonic investigative techniques Ventricular Remodeling |
| title | Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study |
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