title: Cardiac remodelling in the era of aggressive medical therapy: does it still exist?
abstract: OBJECTIVE
  To delineate the natural history of left ventricular remodelling following large anterior myocardial infarction (MI), in the era of aggressive medical therapy.
  
  
  METHODS
  Seventeen selected patients underwent cardiovascular magnetic resonance (CMR) at 2 weeks and 1, 3, 6 and 12 months post infarction.
  
  
  RESULTS
  There was a significant increase in left ventricular (LV) end-diastolic volume index (EDVI) and LV ESVI from 2 weeks to 1 month (P<0.05) but no significant change thereafter. The LV ejection fraction (EF) decreased from 2 weeks to 1 month (P<0.05) and then increased over the year (P=0.02). Throughout the study period the sphericity index increased. There was a significant and progressive decrease in LV mass index over the year, which was associated with a decrease in wall thickness at both the infarct and non-infarct sites. Independent predictors of an early increase in LVESVI were increasing age, increasing CK-MB and not receiving treatment with a statin.
  
  
  CONCLUSIONS
  This study delineates the natural history of left ventricular remodelling in the modern medical era in those patients who have suffered a large anterior MI. Classical remodelling occurred up to 1 month, but thereafter was attenuated. These findings would suggest that remodelling is not as prevalent in the modern era, and that combined medical management with thrombolysis, ACEi, beta-blockers and statins may strongly influence the development of this remodelling.
authors.affiliation: Cardiovascular MR Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK. nickbellenger@doctors.org.uk
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Bellenger
authors.forename: Jonathan M A
authors.initials: JM
authors.lastname: Swinburn
authors.forename: Kim
authors.initials: K
authors.lastname: Rajappan
authors.forename: Avijit
authors.initials: A
authors.lastname: Lahiri
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D020257:Ventricular Remodeling / Q000187:drug effects*