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Titolo:
Recovery of ventricular function after myocardial infarction in the reperfusion era: The healing and early afterload reducing therapy study
Autore:
Solomon, SD; Glynn, RJ; Greaves, S; Ajani, U; Rouleau, JL; Menapace, F; Arnold, JMO; Hennekens, C; Pfeffer, MA;
Indirizzi:
Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiovasc, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 ed, Div Cardiovasc, Boston, MA 02115 USA Toronto Gen Hosp, Toronto, ON, Canada Toronto Gen Hosp Toronto ON CanadaToronto Gen Hosp, Toronto, ON, Canada London Sci Ctr, London, England London Sci Ctr London EnglandLondon Sci Ctr, London, England Geisinger Med Clin, Danville, PA USA Geisinger Med Clin Danville PA USAGeisinger Med Clin, Danville, PA USA Green Lane Hosp, Auckland 3, New Zealand Green Lane Hosp Auckland New Zealand 3 ane Hosp, Auckland 3, New Zealand Univ Miami, Boca Raton, FL USA Univ Miami Boca Raton FL USAUniv Miami, Boca Raton, FL USA
Titolo Testata:
ANNALS OF INTERNAL MEDICINE
fascicolo: 6, volume: 134, anno: 2001,
pagine: 451 - 458
SICI:
0003-4819(20010320)134:6<451:ROVFAM>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
CONVERTING-ENZYME-INHIBITION; CORONARY-ARTERY REPERFUSION; CREATINE-KINASE; SIZE; DYSFUNCTION; DETERMINANT; PREDICTORS; PROGNOSIS; CAPTOPRIL; SURVIVAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Solomon, SD Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiovasc, 75 Francis St, Boston, MA 02115 USA Harvard Univ 75 Francis St Boston MA USA 02115 n, MA 02115 USA
Citazione:
S.D. Solomon et al., "Recovery of ventricular function after myocardial infarction in the reperfusion era: The healing and early afterload reducing therapy study", ANN INT MED, 134(6), 2001, pp. 451-458

Abstract

Background: Patients with reduced left ventricular function and ventricular enlargement after myocardial infarction are at significantly greater riskfor congestive heart failure and death. Nevertheless, recovery of ventricular function occurs in a significant proportion of patients after myocardial infarction, and modern reperfusion strategies have been associated with increased recovery of function. Objective: To determine the extent and predictors of recovery of ventricular function after anterior Q-wave myocardial infarction in the reperfusion era. Design: subgroup analysis of the Healing and Early Afterload Reducing Therapy study. Setting: 35 medical centers in the United States and Canada. Patients: 352 patients with Q-wave anterior myocardial infarction. Intervention: Placebo for 14 days, followed by full-dose (10 mg) ramipril until day 90; low-dose (0.625 mg) ramipril for 90 days; or full-dose ramipril for 90 days. All patients underwent reperfusion therapy. Measurements: Echocardiography was performed on day 1 (before randomization), day 14, and day 90 after myocardial infarction. Left ventricular volumeand ejection fraction were measured and wall-motion analyses were performed at all three time points in 249 patients and at baseline in an additional12 patients who died during follow-up. Echocardiographic and nonechocardiographic predictors of ventricular recovery were examined. Results: By day 90, 55 of 252 (22%) patients who had abnormal ejection fraction and wall-motion abnormalities on day 1 demonstrated complete recoveryof function (ejection fraction in the normal range and infarct segment length of 0%), and an additional 36% (91 of 252 patients) demonstrated partialrecovery of function. At 90 days, 53% (132 of 249) of patients had greaterthan 5% improvement in ejection fraction, whereas only 16% (39 of 249) hada decrease in ejection fraction of more than 5%. The majority of functional improvement occurred by day 14 after infarction. Of various clinical and echocardiographic measures obtained on day 1, peak creatine kinase level was the strongest independent predictor of subsequent recovery of ventricularfunction in multivariate analysis. Each 100-unit increase in peak creatinekinase was associated with a 4.3% decreased odds of recovery (P < 0.001) after adjustment for ejection fraction on day 1, extent of akinesis or dyskinesis, treatment regimen, Killip class, age, and sex. Conclusion: Significant myocardial stunning with subsequent improvement ofventricular function occurred in the majority of patients after Q-wave anterior myocardial infarction. A lower peak level of creatine kinase, an estimate of the extent of necrosis, is independently predictive of recovery of function. Early functional assessment (day 1 after acute myocardial infarction) had limited ability to predict recovery of ventricular function.

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Documento generato il 26/09/20 alle ore 05:25:36