Cardiac remodelling in the era of aggressive medical therapy: does it still exist?

被引:12
作者
Bellenger, NG
Swinburn, JMA
Rajappan, K
Lahiri, A
Senior, R
Pennell, DJ
机构
[1] Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Brompton Hosp, Cardiovasc MR Unit, London, England
[2] Northwick Pk Hosp & Clin Res Ctr, Cardiac Res Dept, Harrow HA1 3UJ, Middx, England
关键词
remodelling; myocardial infarction; cardiovascular magnetic resonance;
D O I
10.1016/S0167-5273(02)00034-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim: 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 week's 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. Conclusion: This study delineates the natural history of left ventricular remodelling in the modem 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 modem era, and that combined medical management with thrombolysis, ACEi, beta-blockers and statins may strongly influence the development of this remodelling. (C) 2002 Elsevier Science Ireland Ltd, All rights reserved.
引用
收藏
页码:217 / 225
页数:9
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