Time course of cardiac structural, functional and electrical changes in asymptomatic patients after myocardial infarction: their inter-relation and prognostic impact.
OBJECTIVE
We prospectively studied the relationship between left ventricular (LV) dilation, dysfunction, electrical instability and death in patients after a first myocardial infarction (MI) without symptoms of heart failure and ischemia.


BACKGROUND
Mechanisms linking LV dysfunction and sudden death in patients after MI remained controversial.


METHODS
Left ventricular volumes, hemodynamics, electrocardiogram and 24-h Holter recordings were sequentially obtained between two days and seven years after MI. Left ventricular catheterization and coronary angiography were performed, and revascularization was performed if appropriate.


RESULTS
Death occurred in 16 (12%) of the 134 patients included; it was of cardiac origin in 14 (88%) and sudden in origin in 12 (75%) patients. Of 37 (28%) patients with LV dilation, 12 died (32%); four patients (5.8%) died in the group without dilation. Left ventricular dilation was closely related to signs of electrical instability, as indicated by a significant correlation between end-diastolic LV volume index, Lown score (r = 0.98, p < 0.0001) and QTc prolongation (r = 0.998, p < 0.01), respectively.


CONCLUSIONS
Patients with progressive remodeling are at increased risk of sudden death in chronic MI. Cardiac electrical instability is closely related to progressive LV dilation. Parameters of electrical instability and remodeling are predictors of sudden death. The findings suggest that remodeling might serve as a link between dysfunction, electrical instability of the heart and sudden death after MI.
Gaudron
P
P
II. Medizinische Universitätsklinik, Klinikum Mannheim der Universität Heidelberg, Germany.
Kugler
I
I
Hu
K
K
Bauer
W
W
Eilles
C
C
Ertl
G
G
D002302:Cardiac Output; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology* / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left; D020257:Ventricular Remodeling