In the post-myocardial infarction (MI) patient with coronary artery disease (CAD)
and left ventricular dysfunction (LVD), ischemia and adverse remodeling hinder myocardial
performance and increase electrical instability. Collectively, the coronary arteries,
myocardium, and conduction system represent the principal pathophysiologic targets
in MI complicated by LVD. Consequently, an accurate assessment of disease severity
in these targets is essential for the design of an effective therapeutic program.
This review describes the current modalities for assessing the key pathophysiologic
targets in post-MI patients with LVD and the effects of systemic factors on cardiac
disease severity.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Conner Memorial Lecture.Circulation. 1994; 90: 2126-2142
- ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction).J Am Coll Cardiol. 2004; 44: 671-719
- ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 2002 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction).Circulation. 2007; 116: 803-877
- Computed tomography coronary angiography.J Am Coll Cardiol. 2006; 48: 1919-1928
- Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study.J Am Coll Cardiol. 2006; 47: 1161-1166
- Sudden cardiac death: structure, function, and time-dependence of risk.Circulation. 1992; 85: I2-I10
- Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction.Circulation. 1987; 76: 44-51
- The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction.N Engl J Med. 1993; 329: 1615-1622
- Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications.Circulation. 2002; 106: 2351-2357
- Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial.JAMA. 2007; 297: 1985-1991
- Identification of viable myocardium.Circulation. 1996; 94: 2674-2680
- Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis.J Am Coll Cardiol. 2002; 39: 1151-1158
- Revascularization in patients with heart failure.CMAJ. 2006; 175: 361-373
- Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function.Circulation. 1999; 100: 1992-2002
- An improved MR imaging technique for the visualization of myocardial infarction.Radiology. 2001; 218: 215-223
- The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.N Engl J Med. 2000; 343: 1445-1453
- Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function.Circulation. 2001; 104: 1101-1107
- Gadolinium cardiovascular magnetic resonance predicts reversible myocardial dysfunction and remodeling in patients with heart failure undergoing beta-blocker therapy.Circulation. 2003; 108: 1945-1953
- Lack of myocardial perfusion immediately after successful thrombolysis: a predictor of poor recovery of left ventricular function in anterior myocardial infarction.Circulation. 1992; 85: 1699-1705
- Clinical implications of the ‘no reflow' phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction.Circulation. 1996; 93: 223-228
- Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.Circulation. 1998; 97: 765-772
- Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era: GISSI-2 results.Circulation. 1993; 87: 312-322
- Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia.N Engl J Med. 1996; 335: 1933-1940
- A randomized study of the prevention of sudden death in patients with coronary artery disease.N Engl J Med. 1999; 341: 1882-1890
- Prediction of sudden cardiac death: appraisal of the studies and methods assessing the risk of sudden arrhythmic death.Circulation. 2003; 108: 110-115
- Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction.JAMA. 1998; 279: 387-391
- The mortality predictive power of discharge electrocardiogram after first acute myocardial infarction.Am Heart J. 1985; 109: 1231-1237
- QRS duration does not predict occurrence of ventricular tachyarrhythmias in patients with implanted cardioverter-defibrillators.J Am Coll Cardiol. 2005; 46: 310-316
- The effect of cardiac resynchronization on morbidity and mortality in heart failure.N Engl J Med. 2005; 352: 1539-1549
- Heart rate variability and dispersion of QT interval in patients with vulnerability to ventricular tachycardia and ventricular fibrillation after previous myocardial infarction.J Am Coll Cardiol. 1997; 30: 1331-1338
- QT dispersion and mortality after myocardial infarction.Lancet. 1995; 345: 945-948
- Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction: results of a prospective, long-term follow-up study.Circulation. 1998; 97: 2543-2550
- QT dispersion: problems of methodology and clinical significance.J Cardiovasc Electrophysiol. 1994; 5: 672-685
- T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: prospective comparison with conventional risk markers.J Cardiovasc Electrophysiol. 1998; 9: 1258-1268
- Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction.J Am Coll Cardiol. 2006; 47: 456-463
- Prognostic significance of risk stratifiers of mortality, including T wave alternans, after acute myocardial infarction: results of a prospective follow-up study.J Cardiovasc Electrophysiol. 2001; 12: 645-652
- Prediction of long-term outcomes by signal-averaged electrocardiography in patients with unsustained ventricular tachycardia, coronary artery disease, and left ventricular dysfunction.Circulation. 2001; 104: 436-441
- Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery.N Engl J Med. 1997; 337: 1569-1575
- Definition of the best prediction criteria of the time domain signal-averaged electrocardiogram for serious arrhythmic events in the postinfarction period.J Am Coll Cardiol. 1995; 25: 908-914
- Hormones and hemodynamics in heart failure.N Engl J Med. 1999; 341: 577-585
- Adrenergic effects on the biology of the adult mammalian cardiocyte.Circulation. 1992; 85: 790-804
- Angiotensin receptors and their antagonists.N Engl J Med. 1996; 334: 1649-1654
- Heart failure.N Engl J Med. 2003; 348: 2007-2018
- Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study.Circulation. 1999; 99: 2626-2632
- The relationship of epinephrine excretion to serum lipid levels: the Normative Aging Study.Metabolism. 1994; 43: 509-513
- Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system.N Engl J Med. 1996; 334: 374-381
- Renin-angiotensin system and angiotensin receptor blockers in the metabolic syndrome.Circulation. 2004; 110: 1507-1512
- Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease.N Engl J Med. 1990; 322: 1700-1707
- Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris: a 16-year follow-up of the Primary Prevention Study in Göteborg, Sweden.Eur Heart J. 1997; 18: 754-761
- Antecedent hypertension and heart failure after myocardial infarction.J Am Coll Cardiol. 2002; 39: 1182-1188
- Pharmacologic therapies across the continuum of left ventricular function.Am J Cardiol. 2008; : 21G-28G
- Device therapies in the post-myocardial infarction patient with left ventricular dysfunction.Am J Cardiol. 2008; : 29G-37G
- Percutaneous coronary intervention for myocardial infarction with left ventricular dysfunction.Am J Cardiol. 2008; : 38G-41G
- Surgical therapies for post-myocardial infarction patients.Am J Cardiol. 2008; : 42G-46G
Article info
Footnotes
Statement of author disclosure: Please see the Author Disclosures section at the end of this article.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
