- 作者：Nazario Carrabba ; carddept@tin.it ; Guido Parodi ; Renato Valenti ; Angela Migliorini ; Benedetta Bellandi ; David Antoniucci.
- 关键词：Reverse remodeling ; Myocardial infarction ; Angioplasty ; Heart failure
- 刊名：Atherosclerosis
- 出版年：2012
- 期刊代码：28_00219150
- 类别：med
- 出版时间：May, 2012
- 卷：222
- 期：1
- 页码：123-128
- 文件大小：359 K
Aims
Thus far, the prognostic value of reverse left ventricular (LV) remodeling after ST-elevation acute myocardial infarction (STEMI) has not been fully evaluated. We sought to investigate the incidence, major determinants, and long-term clinical significance of reverse LV remodeling in a large series of STEMI patients successfully treated with primary percutaneous coronary intervention (P-PCI).Methods and results
Serial complete 2D-echocardiograms were obtained within 24 h after P-PCI, and at 1 and 6 months in 512 consecutive reperfused STEMI patients. Reverse remodeling was defined as a reduction >10%in LV end-systolic volume (LVESV) at 6 month follow-up. Reverse LV remodeling occurred in 49%of study population. At follow-up (41.6 卤 23 months), late heart failure (HF) rate was significantly higher among patients without reverse LV remodeling as compared with those with it (32%vs. 11%, P < 0.0001). At multivariate analysis, independent predictors of reverse LV remodeling were a small infarct size measured as peak creatine kinase value (P < 0.0001), a small functional myocardial damage measured as wall motion score index within the infarct zone (P = 0.018) and baseline LVESV (P < 0.0001). After adjustment for several clinical, echographic and angiographic variables, Cox analysis identified reverse LV remodeling as the only beneficial independent predictor of long-term heart failure-free survival (HR: 0.44, 95%CI: 0.275-0.722).
Conclusions
Reverse LV remodeling occurred in half of successfully reperfused STEMI patients. Small structural and functional myocardial damages within the infarct zone are the major determinants of reverse LV remodeling. As expression of effective myocardial salvage by P-PCI, the reverse remodeling is an important predictor of favorable long-term outcome.