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European Heart Journal Advance Access published online on November 29, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi011
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

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

João C. Silva 1*, Carlos E. Rochitte 2, José S. Júnior 3, Jeanne Tsutsui 4, Joalbo Andrade 2, Eulógio E. Martinez 5, Paulo J. Moffa 6, José C. Menegheti 3, Roberto Kalil-Filho 1, José F. Ramires 1, and José C. Nicolau 7

1 Acute 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
2 Magnetic Resonance Imaging Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
3 Nuclear Medicine Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
4 Echocardiography Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
5 Catheterization Laboratory, Heart Institute (InCor), University of São Paulo Medical School, Brazil
6 Electrocardiology Sector, Heart Institute (InCor), University of São Paulo Medical School, Brazil
7 Acute Coronary Heart Institute (InCor), University of São Paulo Medical School, Brazil

* To whom correspondence should be addressed.
João C. Silva, E-mail: joaoclima{at}uol.com.br


  Abstract

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 12h 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.

Keywords: Ventricular remodelling; Myocardial function; Myocardial contractility; Late coronary recanalization.
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