Different patterns of left ventricular enlargement and long-term prognosis after reperfused acute myocardial infarction Différents modes de la dilatation du ventricule gauche et le pronostic à long terme après un infarctus du myocarde traité par reperfusion à la phase aiguë

Summary Background. — Dilation of end-systolic and end-diastolic volumes (ESV, EDV) has been used to define left ventricular remodelling after acute myocardial infarction (MI), but the prognostic significance of different enlargement patterns has not been evaluated fully. Aim. — To analyse the evolution of left ventricular volumes and parameters of global and regional contractility and their correlations with long-term prognosis in patients treated by angioplasty in the acute phase of MI. Methods. — Seventy-four patients (mean age 56 ± 13 years; 77% men), treated successfully by angioplasty in the acute phase of MI, were included prospectively. Significant enlargement of left ventricular volumes was defined as a greater than 20% increase between acute phase and 6-month control, assessed by contrast ventriculography. Clinical follow-up was obtained for all patients at 82 ± 19 months. Results. — Four groups were identified based on volume evolution: Group I (n = 29, 39%; no volume enlargement); Group II (n = 8, 11%; isolated EDV enlargement); Group III (n = 10, 14%; isolated ESV enlargement); Group IV (n = 27, 36%; ESV plus EDV enlargement). Global left ventricular ejection fraction increased in Groups I (p = 0.001) and II (p = 0.037), but decreased