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Impact of coronary revascularization and transmural extent of scar on regional left ventricular remodelling

Citation

Chan, J and Khafagi, F and Young, AA and Cowan, BR and Thompson, C and Marwick, TH, Impact of coronary revascularization and transmural extent of scar on regional left ventricular remodelling, European Heart Journal, 29, (13) pp. 1608-1617. ISSN 0195-668X (2008) [Refereed Article]

Copyright Statement

Copyright The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

DOI: doi:10.1093/eurheartj/ehn247

Abstract

Aims: Transmural extent (TME) of myocardial scar, contractile reserve, and perfusion all predict improvement in regional myocardial function after coronary revascularization. We sought their association with regional remodelling after infarction. Methods and results: We studied 89 patients (age 62 10 years) with left ventricular (LV) dysfunction, at least 1 month post infarction. Viability was identified by TME < 75% on contrast-enhanced magnetic resonance imaging (ce-MRI), augmentation at low-dose dobutamine echocardiography (DbE), or >60% uptake on delayed redistribution on TI-201 SPECT (single photon emission computed tomography). Coronary revascularization was performed in 36 patients. Regional LV end-diastolic volume (EDV) and end-systolic volume, and ejection fraction were measured with MRI at baseline and after a median follow-up of 18 months.Of 357 segments identified with subendocardial infarction (TME 0-25%) on ce-MRI, 176 were revascularized. Subendocardial scar segments were associated with reverse regional remodeling during follow-up. Revascularization was an independent correlate of change in EDV, but TME and revascularization showed no interaction with respect to their influence on regional volumes. Contractile reserve was present on DbE in 228 segments, of which 129 were TME 0-25%; remodelling was associated with intervention in non-transmural infarcts showing viability by DbE. Viability was identified by TI-201 SPECT in 381 segments (233 with TME 0-25%), but viability by SPECT was not associated with reverse remodelling. No significant reverse remodelling occurred in segments with intermediate scar thickness (TME 26-75%) or transmural scar, independent of revascularization or viability by DbE or TI-SPECT. Conclusion: Reverse regional remodelling is associated with subendocardial infarction, especially in the setting of contractile reserve and revascularization.

Item Details

Item Type:Refereed Article
Keywords:Dobutamine echo; Remodelling; Revascularization; SPECT; Viable myocardium
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:90775
Year Published:2008
Web of Science® Times Cited:15
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-04-23
Last Modified:2014-12-17
Downloads:0

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