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Open Access Research

Left ventricular remodeling after acute myocardial infarction: the influence of viability and revascularization - an echocardiographic substudy of the VIAMI-trial

Ramon B van Loon1*, Gerrit Veen1, Otto Kamp1, Leo HB Baur2 and Albert C van Rossum1

Author Affiliations

1 Department of Cardiology, 5F003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

2 Department of Cardiology, Atrium Medical Center Parkstad, 6419 PC Heerlen and Faculty of Health, Medicine and Life Sciences, University Maastricht, 6200, MD, Maastricht, The Netherlands

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Trials 2014, 15:329  doi:10.1186/1745-6215-15-329

Published: 18 August 2014

Abstract

Background

Viability seems to be important in preventing ventricular remodeling after acute myocardial infarction (AMI). We investigated the influence of viability, as demonstrated with low-dose dobutamine echocardiography, and the role of early revascularization on the process of left ventricular (LV) remodeling after AMI.

Methods

We retrospectively investigated 224 patients who were initially included in the viability-guided angioplasty after acute myocardial infarction-trial (VIAMI-trial). Patients in the VIAMI-trial did not undergo a primary or rescue percutaneous coronary intervention and were stable in the early in-hospital phase. Patients underwent viability testing within 72 hours after AMI. Patients with viability were randomized to an invasive strategy or an ischemia-guided strategy. Follow-up echocardiography was performed at a mean of 205 days. In this echocardiographic substudy, patients were divided into three new groups: group 1, viable and revascularized before follow-up echocardiogram; group 2, viable, but medically treated; and group 3, non-viable patients.

Results

Group 1 showed preservation of LV volume indices. The ejection fraction (EF) increased significantly from 54.0% to 57.5% (P = 0.047). Group 2 showed a significant increase in LV volume indices with no improvement in EF (53.3% versus 53.0%, P = 0.86). Group 3 showed a significant increase in LV volume indices, with a decrease in EF from 53.5% to 49.1% (P = 0.043). Multivariate logistic regression analysis indicated the number of viable segments and revascularization during follow-up as independent predictors for EF improvement, especially in patients with lower EF at baseline.

Conclusion

Viability early after AMI is associated with improvement in LV function after revascularization. When viable myocardium is not revascularized, the LV tends to remodel with increased LV volumes, without improvement of EF. Absence of viability results in ventricular dilatation and deterioration of EF, irrespective of revascularization status.

Trial registration

NCT00149591 (assigned: 6 September 2005).

Keywords:
Myocardial infarction; Viability; Echocardiography; Percutaneous coronary intervention; Remodeling