title: Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance.
abstract: BACKGROUND
  Left ventricular (LV) remodeling following acute myocardial infarction (MI) is difficult to predict at an individual level although a possible interfering role of vascular function has yet to be considered to date. This study aimed to determine the extent to which this LV remodeling is influenced by the concomitant evolution of vascular function and LV loading conditions, as assessed by phase-contrast Cardiovascular Magnetic Resonance (CMR) of the ascending aorta.
  
  
  METHODS
  CMR was performed in 121 patients, 2-4 days after reperfusion of a first ST-segment elevation myocardial infarction and 6 months thereafter. LV remodeling was: (i) assessed by the 6-month increase in end-diastolic volume (EDV) and/or ejection fraction (EF) and (ii) correlated with the indexed aortic stroke volume (mL.m-2), determined by a CMR phase-contrast sequence, along with derived functional vascular parameters (total peripheral vascular resistance (TPVR), total arterial compliance index, effective arterial elastance).
  
  
  RESULTS
  At 6 months, most patients were under angiotensin enzyme converting inhibitors (86%) and beta-blockers (84%) and, on average, all functional vascular parameters were improved whereas blood pressure levels were not. An increase in EDV only (EDV+/EF-) was documented in 17% of patients at 6 months, in EF only (EDV-/EF+) in 31%, in both EDV and EF (EDV+/EF+) in 12% and neither EDV nor EF (EDV-/EF-) in 40%. The increase in EF was mainly and independently linked to a concomitant decline in TPVR (6-month change in mmHg.min.m2.L-1, EDV-/EF-: +1 ± 8, EDV+/EF-: +3 ± 9, EDV-/EF+: -7 ± 6, EDV+/EF+: -15 ± 20, p < 0.001) while the absence of any EF improvement was associated with high persisting rates of abnormally high TPVR at 6 months (EDV-/EF-: 31%, EDV+/EF-: 38%, EDV-/EF+: 5%, EDV+/EF+: 13%, p = 0.007). By contrast, the 6-month increase in EDV was mainly dependent on cardiac as opposed to vascular parameters and particularly on the presence of microvascular obstruction at baseline (EDV-/EF-: 37%, EDV+/EF-: 76%, EDV-/EF+: 38%, EDV+/EF+: 73%, p = 0.003).
  
  
  CONCLUSIONS
  LV remodeling following reperfused MI is strongly influenced by the variable decrease in systemic vascular resistance under standard care vasodilating medication. The CMR monitoring of vascular resistance may help to tailor these medications for improving vascular resistance and consequently, LV ejection fraction.
  
  
  BACKGROUND
  NCT01109225 on ClinicalTrials.gov site (April, 2010).
authors.affiliation: CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France.|INSERM, UMR-1116, Nancy, F-54000, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huttin
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|CHRU-Nancy, Department of Radiology, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Mandry
authors.affiliation: CHU-Clermont-Ferrand, Department of Cardiology, Clermont-Ferrand, F-63000, France.|Université d'Auvergne, UMR6284, Clermont-Ferrand, F-63000, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Emilien
authors.initials: E
authors.lastname: Micard
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Freddy
authors.initials: F
authors.lastname: Odille
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Beaumont
authors.affiliation: INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.affiliation: INSERM, UMR-947, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Felblinger
authors.affiliation: CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France.|INSERM, UMR-1116, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Camenzind
authors.affiliation: INSERM, UMR-1116, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Faïez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: INSERM, UMR-1116, Nancy, F-54000, France.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.|INSERM CIC 1433, Nancy, F-54000, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: INSERM, UMR-1116, Nancy, F-54000, France. py.marie@chu-nancy.fr.|Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France. py.marie@chu-nancy.fr.|CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Allée du Morvan, 54500, Vandœuvre, France. py.marie@chu-nancy.fr.
authors.forename: Pierre Y
authors.initials: PY
authors.lastname: Marie
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001011:Aorta / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D014664:Vasodilation; D014665:Vasodilator Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents
keywords: CMR; Cardiac remodeling; Cardiovascular magnetic resonance; Hemodynamics; Myocardial infarction; Peripheral vascular resistance