Natural course of angiographic parameters after myocardial infarction: an evaluation in the prethrombolytic and pre-angiotensin converting enzyme inhibition era.
BACKGROUND
After myocardial infarction, left ventricular dilation is a frequent cause of cardiac insufficiency, which is associated with high morbidity and mortality. In this angiographic study, the natural course of postinfarction ventricular dilation could be followed up because patients undergoing revascularization procedures were excluded and only some few patients received angiotensin-converting enzyme inhibitors.


RESULTS
Of 85 patients suffering from angina after myocardial infarction, 59 could be examined twice by angiocardiography in a mean interval of 52 +/- 14 months; 37 of the 59 patients had sustained posterior myocardial infarction, 20 had anterior myocardial infarction, and 2 had both. During follow-up, end-diastolic volume index increased from 100 +/- 27 mL/m2 to 110 +/- 34 mL/m2; in 26 of the 59 patients the increase was greater than 15 mL/m2. Irrespective of the time since infarction, patients with an end-diastolic volume index greater than 100 mL/m2 and an ejection fraction less than 50% at the time of first angiography were at high risk of progressive ventricular dilation and further deterioration of left ventricular function (for both, P = .003). This process was independent of extent of coronary artery involvement and coronary disease progression. Multivariate analysis identified ejection fraction at the time of index angiography as the strongest predictor of further left ventricular dilation (P = .0004).


CONCLUSIONS
Continuing left ventricular dilation occurs in less than half the patients who had myocardial infarction. Left ventricular ejection fraction is the most sensitive parameter to predict the risk of ventricular dilation after infarction.
Reynen
K
K
Heart Center Dresden, Germany.
Bachmann
K
K
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
D000806:Angiotensin-Converting Enzyme Inhibitors