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. 1994 Mar;71(3):249–253. doi: 10.1136/hrt.71.3.249

Long-term function in the remote region after myocardial infarction: importance of significant coronary stenoses in the non-infarct-related artery.

C P de Albuquerque 1, R Kalil-Filho 1, G Gerstenblith 1, O Nakano 1, V Barbosa 1, G Bellotti 1, F Pileggi 1, B Tranchesi 1
PMCID: PMC483662  PMID: 8142194

Abstract

BACKGROUND--Left ventricular (LV) function is the most important determinant of outcome after a myocardial infarction. Global LV function after a myocardial infarction is affected not only by wall motion in the infarct zone but also by regional function in the contralateral territory. It was hypothesised that the presence of significant stenoses in coronary arteries supplying the contralateral territory might influence the ability of this region to compensate for damaged myocardium after a myocardial infarction. METHODS AND RESULTS--79 patients treated with thrombolysis for acute myocardial infarction had coronary and ventricular angiograms within 24 h and at a mean follow up of 12 months after myocardial infarction. Wall motion in the contralateral territory was analysed and scored by the centre line method and the change over time was correlated with the presence or absence of significant (> 70%) diameter stenoses in the non-infarct-related artery. Mean (SD) contralateral territory motion worsened, from 0.74 (1.78) to -1.55 (2.06) SD chord (p < 0.001) in 40 patients with stenoses, whereas contralateral territory motion improved from -0.02 (2.4) to 0.63 (2.21) SD chord (p < 0.05) in the 39 patients without coronary stenoses. The same pattern was present whether or not the infarct artery was patent. The global left ventricular ejection fraction at 12 months was also related to contralateral territory motion (r = 0.71, p < 0.001) and to the presence of coronary stenoses (54 (15)% in those with coronary stenoses and 62 (16)% in those without, p < 0.05). CONCLUSION--The results demonstrate that significant stenoses in arteries supplying the non-infarct territory adversely affect global and regional left ventricular function after a transmural infarction. Non-infarct artery anatomy should be considered in intervention strategies to improve left ventricular function after acute myocardial infarction.

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Selected References

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  1. Bolli R. Myocardial 'stunning' in man. Circulation. 1992 Dec;86(6):1671–1691. doi: 10.1161/01.cir.86.6.1671. [DOI] [PubMed] [Google Scholar]
  2. Braunwald E., Rutherford J. D. Reversible ischemic left ventricular dysfunction: evidence for the "hibernating myocardium". J Am Coll Cardiol. 1986 Dec;8(6):1467–1470. doi: 10.1016/s0735-1097(86)80325-4. [DOI] [PubMed] [Google Scholar]
  3. Grines C. L., Topol E. J., Califf R. M., Stack R. S., George B. S., Kereiakes D., Boswick J. M., Kline E., O'Neill W. W. Prognostic implications and predictors of enhanced regional wall motion of the noninfarct zone after thrombolysis and angioplasty therapy of acute myocardial infarction. The TAMI Study Groups. Circulation. 1989 Aug;80(2):245–253. doi: 10.1161/01.cir.80.2.245. [DOI] [PubMed] [Google Scholar]
  4. Homans D. C., Sublett E., Elsperger K. J., Schwartz J. S., Bache R. J. Mechanisms of remote myocardial dysfunction during coronary artery occlusion in the presence of multivessel disease. Circulation. 1986 Sep;74(3):588–596. doi: 10.1161/01.cir.74.3.588. [DOI] [PubMed] [Google Scholar]
  5. Jaarsma W., Visser C. A., Eenige van M. J., Res J. C., Funke Kupper A. J., Verheugt F. W., Roos J. P. Prognostic implications of regional hyperkinesia and remote asynergy of noninfarcted myocardium. Am J Cardiol. 1986 Sep 1;58(6):394–398. doi: 10.1016/0002-9149(86)90002-0. [DOI] [PubMed] [Google Scholar]
  6. Muller D. W., Topol E. J., Ellis S. G., Sigmon K. N., Lee K., Califf R. M. Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. Am Heart J. 1991 Apr;121(4 Pt 1):1042–1049. doi: 10.1016/0002-8703(91)90661-z. [DOI] [PubMed] [Google Scholar]
  7. Rahimtoola S. H. The hibernating myocardium. Am Heart J. 1989 Jan;117(1):211–221. doi: 10.1016/0002-8703(89)90685-6. [DOI] [PubMed] [Google Scholar]
  8. Sandler H., Dodge H. T. The use of single plane angiocardiograms for the calculation of left ventricular volume in man. Am Heart J. 1968 Mar;75(3):325–334. doi: 10.1016/0002-8703(68)90089-6. [DOI] [PubMed] [Google Scholar]
  9. Schulman S. P., Achuff S. C., Griffith L. S., Humphries J. O., Taylor G. J., Mellits E. D., Kennedy M., Baumgartner R., Weisfeldt M. L., Baughman K. L. Prognostic cardiac catheterization variables in survivors of acute myocardial infarction: a five year prospective study. J Am Coll Cardiol. 1988 Jun;11(6):1164–1172. doi: 10.1016/0735-1097(88)90277-x. [DOI] [PubMed] [Google Scholar]
  10. Schuster E. H., Bulkley B. H. Early post-infarction angina. Ischemia at a distance and ischemia in the infarct zone. N Engl J Med. 1981 Nov 5;305(19):1101–1105. doi: 10.1056/NEJM198111053051901. [DOI] [PubMed] [Google Scholar]
  11. Sheehan F. H., Bolson E. L., Dodge H. T., Mathey D. G., Schofer J., Woo H. W. Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation. 1986 Aug;74(2):293–305. doi: 10.1161/01.cir.74.2.293. [DOI] [PubMed] [Google Scholar]
  12. Sheehan F. H., Mathey D. G., Schofer J., Krebber H. J., Dodge H. T. Effect of interventions in salvaging left ventricular function in acute myocardial infarction: a study of intracoronary streptokinase. Am J Cardiol. 1983 Sep 1;52(5):431–438. doi: 10.1016/0002-9149(83)90002-4. [DOI] [PubMed] [Google Scholar]
  13. Stack R. S., Phillips H. R., 3rd, Grierson D. S., Behar V. S., Kong Y., Peter R. H., Swain J. L., Greenfield J. C., Jr Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. J Clin Invest. 1983 Jul;72(1):84–95. doi: 10.1172/JCI110987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Stadius M. L., Davis K., Maynard C., Ritchie J. L., Kennedy J. W. Risk stratification for 1 year survival based on characteristics identified in the early hours of acute myocardial infarction. The Western Washington Intracoronary Streptokinase Trial. Circulation. 1986 Oct;74(4):703–711. doi: 10.1161/01.cir.74.4.703. [DOI] [PubMed] [Google Scholar]
  15. Taylor G. J., Humphries J. O., Mellits E. D., Pitt B., Schulze R. A., Griffith L. S., Achuff S. C. Predictors of clinical course, coronary anatomy and left ventricular function after recovery from acute myocardial infarction. Circulation. 1980 Nov;62(5):960–970. doi: 10.1161/01.cir.62.5.960. [DOI] [PubMed] [Google Scholar]
  16. Tranchesi B., Jr, Bellotti G., Chamone D. F., Verstraete M. Effect of combined administration of saruplase and single-chain alteplase on coronary recanalization in acute myocardial infarction. Am J Cardiol. 1989 Jul 15;64(3):229–232. doi: 10.1016/0002-9149(89)90464-5. [DOI] [PubMed] [Google Scholar]
  17. Tranchesi B., Jr, Chamone D. F., Cobbaert C., Van de Werf F., Vanhove P., Verstraete M. Coronary recanalization rate after intravenous bolus of alteplase in acute myocardial infarction. Am J Cardiol. 1991 Jul 15;68(2):161–165. doi: 10.1016/0002-9149(91)90737-6. [DOI] [PubMed] [Google Scholar]
  18. Vanoverschelde J. L., Wijns W., Depré C., Essamri B., Heyndrickx G. R., Borgers M., Bol A., Melin J. A. Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium. Circulation. 1993 May;87(5):1513–1523. doi: 10.1161/01.cir.87.5.1513. [DOI] [PubMed] [Google Scholar]

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