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European Heart Journal Advance Access originally published online on December 18, 2008
European Heart Journal 2009 30(5):566-575; doi:10.1093/eurheartj/ehn529
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

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

Stefania Funaro1, Giuseppe La Torre2, Mariapina Madonna3, Leonarda Galiuto4, Antonio Scarà4, Alessandra Labbadia3, Emanuele Canali3, Antonella Mattatelli3, Francesco Fedele3, Francesco Alessandrini1, Filippo Crea4, Luciano Agati1,* on behalf of AMICI Investigators

1 Department of Cardiology, Catholic University of the Sacred Heart, Campobasso, Italy
2 Epidemiology and Biostatistics Unit, Catholic University of the Sacred Heart, Rome, Italy
3 Department of Cardiology, ‘La Sapienza’ University of Rome, Italy
4 Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy

Received 2 July 2008; revised 19 October 2008; accepted 18 November 2008; online publish-ahead-of-print 18 December 2008.

* Corresponding author. Viale del Policlinico 155, 00161 Roma, Italy. Tel: +39 06 49979008, Fax: +39 06 49979060, Email: luciano.agati{at}uniroma1.it

See page 530 for the editorial comment on this article (doi:10.1093/eurheartj/ehp043)

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.

Key Words: Myocardial contrast echocardiography • Acute myocardial infarction


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