Cardiac remodelling in the era of aggressive medical therapy: does it still exist?
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.
Bellenger
Nicholas G
NG
Cardiovascular MR Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK. nickbellenger@doctors.org.uk
Swinburn
Jonathan M A
JM
Rajappan
Kim
K
Lahiri
Avijit
A
Senior
Roxy
R
Pennell
Dudley J
DJ
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*