Coronary artery diseaseEffect of Left Ventricular Scar Size, Location, and Transmurality on Left Ventricular Remodeling With Healed Myocardial Infarction
Section snippets
Methods
To increase the likelihood of LV remodeling in long-term survivors of MI, only patients with high-risk complicated MI were included in the present study.
Patients were drawn from a registry of long-term survivors originally included in the Comparison of the Effects of Losartan and Captopril on Mortality and Morbidity in Patients Following Acute Myocardial Infarction (OPTIMAAL) trial at a single center (Stavanger, Norway). The OPTIMAAL trial14 compared losartan (50 mg) with captopril (150 mg) in
Results
Fifty-seven patients (age 68.7 ± 10 years) were included in the study 4.4 ± 0.4 years after their last MI. Baseline characteristics are listed in Table 1. In the acute phase, 33 patients received thrombolytic treatment, 5 patients underwent percutaneous coronary intervention, and 4 patients underwent coronary artery bypass grafting. During follow-up (in the OPTIMAAL trial), 15 patients underwent percutaneous coronary intervention and an additional 5 patients underwent coronary artery bypass
Discussion
The present study is the first to show that scar size, rather than location and transmurality, is the primary determinant of LV remodeling in long-term survivors of MI. These results are in apparent contrast to the conventional perception that scar location and transmurality are the important determinants of LV remodeling. Our findings imply that minimizing or reducing scar size appears to be critical to preventing long-term adverse remodeling irrespective of the location of the initial injury.
Acknowledgment
We acknowledge Fredrikke Wick, RT, and Bent Erdal, RT (CMR technicians) for important contributions and Jorunn Nielsen, RN, and Torbjørn Aarsland, RN (Stavanger Health Research) for patient follow-up and conduct of the study.
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The OPTIMAAL trial was sponsored mainly by Merck, Sharp, & Dohme Research Laboratories, West Point, Pennsylvania, and supported by Helse Vest Grant No. 911017 supplied by government authorities. Amersham Health, a division of GE Healthcare Ltd., Little Chalfont, United Kingdom, supplied the contrast needed to perform the study.