Association Between Myocardial Mechanics and Ischemic LV Remodeling

Abstract

The outcomes associated with heart failure after myocardial infarction are still poor. Both global and regional left ventricular (LV) remodeling are associated with the progression of the post-infarct patient to heart failure, but although global remodeling can be accurately measured, regional LV remodeling has been more difficult to investigate. Preliminary evidence suggests that post-MI assessment of LV mechanics using stress and strain may predict global (and possibly regional) LV remodeling. A method of predicting both global and regional LV remodeling might facilitate earlier, targeted, and more extensive clinical intervention in those most likely to benefit from novel interventions such as cell therapy.

Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance

“…ACE inhibitors are known to favorably alter ischemic LV remodeling with hemodynamic effects, including the lowering of both TPVR and volume expansion, leading to a reduction in LV wall stress, a main stimulus for adverse remodeling [1, 24–26]. However, only half of our patients received, at 6 months, the dose prescribed for ACE inhibitors targeted in post-MI trials, in accordance with results from previous observational studies [27].…”

Macrophages in the Remodeling Failing Heart

“…The authors attribute the proliferative activity of macrophages in viable segments to increased wall stress that activates a proliferative program in macrophages, in part through MAPK-dependent actions. However, left ventricular wall stress is inversely proportionate to wall thickness 18 and would be expected to be higher in thinner infarcted segments. The spatial selectivity of the macrophage response may be explained by the microenvironmental differences between the structurally preserved non-infarcted myocardium and the collagen-rich mature scar.…”

More than 10 years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice?

“…68 In recent STEMI, LV remodeling represents one of the most important prognostic determinants 69,70 and it tends to be more pronounced as the patient is treated long after symptom onset. 68 In recent STEMI, LV remodeling represents one of the most important prognostic determinants 69,70 and it tends to be more pronounced as the patient is treated long after symptom onset.…”