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European Heart Journal Advance Access originally published online on November 29, 2004
European Heart Journal 2005 26(1):36-43; doi:10.1093/eurheartj/ehi011
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Clinical research

Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging

João C. Silva1,*, Carlos E. Rochitte2, José S. Júnior3, Jeanne Tsutsui4, Joalbo Andrade2, Eulógio E. Martinez5, Paulo J. Moffa6, José C. Menegheti3, Roberto Kalil-Filho1, José F. Ramires1 and José C. Nicolau7

1Acute Coronary Disease Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Enéas de Carvalho de Aguiar, 44, 2nd Floor, 05403–000, São Paulo, Brazil
2Magnetic Resonance Imaging Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
3Nuclear Medicine Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
4Echocardiography Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
5Catheterization Laboratory, Heart Institute (InCor), University of São Paulo Medical School, Brazil
6Electrocardiology Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
7Acute Coronary Heart Institute (InCor), University of São Paulo Medical School, Brazil

Received December 10, 2003; revised August 26, 2004; accepted September 3, 2004 * Corresponding author. Tel: +55 11 30695058; fax: +55 11 30883809. E-mail address: joaoclima{at}uol.com.br

Aims To assess the recanalization effects of post-myocardial infarction (MI) on left ventricular (LV) remodelling and contractility in relation to conservative therapy.

Methods and results Thirty-six patients with occluded infarct-related artery between 12 h and 14 days post-anterior MI were randomized to percutaneous coronary intervention (PCI group) or conservative therapy (no-PCI group). Magnetic resonance imaging was performed at enrolment and after 6 months. The left ventricle was divided into infarct, adjacent, and remote segments. There was no difference in relation to LV volume between groups at the 6 month follow-up. Change in LV ejection fraction was favourable to the PCI group: 5.00% vs. –0.76%, P=0.012. Change in circumferential shortening (Ecc) of the remote segments in the PCI group was significantly better than in the no-PCI group: –1.67±6.30% vs. 0.29±6.02%, P<0.001. Infarct size and LV mass were similar between groups.

Conclusions Late recanalization improved LV ejection fraction and myocardial contractility in late follow-up, but did not change the ventricular volumes. Improvement in the left ventricle global and regional contractility may benefit the long-term outcome in post-MI patients with sustained patency of the infarct-related artery.

Key Words: Ventricular remodelling • Myocardial function • Myocardial contractility • Late coronary recanalization


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