title: Late cardiac remodeling after primary percutaneous coronary intervention-five-year cardiac magnetic resonance imaging follow-up.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PPCI) preserves function and improves survival. The late effects of PPCI on left ventricular remodeling, however, have not yet been investigated on cardiac magnetic resonance imaging (CMRI).
  
  
  RESULTS
  Twenty-five patients with acute myocardial infarction (AMI) treated with PPCI underwent CMRI within 10 days, at 4 months and at 5 years. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume were quantified on cine images. Infarct mass and transmural extent of infarction were quantified on contrast-enhanced imaging. In all patients EDV increased significantly in the early phase (192 ± 40 ml to 211 ± 49 ml, P ≤ 0.01) and LVEF improved significantly (42 ± 9% to 46 ± 9%, P=0.02). In the late phase (>4 months) no significant changes were observed (LVEF 44 ± 9%, P=0.07; EDV 216 ± 68 ml, P=0.38). Three different groups could be identified. One-third (32%) had no dilatation at all; one-third (32%) had limited dilatation at 4 months without progression later; and 36% had progressive dilatation both at 4 months and at late follow-up. This third group had an average increase in EDV of 20% in the acute phase followed by an additional 13%. The strongest predictor for progressive dilatation was infarct mass.
  
  
  CONCLUSIONS
  Even in the era of PPCI for AMI followed by optimal medical therapy, one-third of patients had progressive dilatation, which was best predicted by infarct mass.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Tirza
authors.initials: T
authors.lastname: Springeling
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kirschbaum
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.forename: Timo
authors.initials: T
authors.lastname: Baks
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Karamermer
authors.forename: Carl
authors.initials: C
authors.lastname: Schulz
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ouhlous
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Duncker
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.forename: Patrick W J C
authors.initials: PW
authors.lastname: Serruys
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Robert-Jan M
authors.initials: RJ
authors.lastname: van Geuns
mesh_terms: D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D013318:Stroke Volume; D020257:Ventricular Remodeling