부산대학교 도서관

Background: Cardiac remodeling after myocardial infarction represents a consequence of loss of viable myocardium that leads to left ventricular dilatation. This complex process involves the cardiomyocytes, the blood vessels and the extracellular matrix. Once the viability of the myocytes is compromised, the end-diastolic volume (EDV) increases as a response to a larger preload. The activation of biochemical intracellular signaling reactions will promote dilatation, hypertrophy and the synthesis of a collagen scar tissue. Material and Methods: Our study included 274 subjects admitted in the Cardiology Department of the Emergency Clinical County Hospital with acute coronary syndrome who underwent interventional and surgical myocardial revascularization. The patients were equally divided into two groups depending on whether they had chronic kidney disease (CKD) and several markers were investigated whether they correlate with the incidence of the cardiac remodeling, defined as a decrease of the EDV with more than 20%. The compared groups were matched by age, sex, anthropometric data, and treatment. Results: The LV remodeling signs on the echocardiography were reported in 41 subjects from the CKD group, whereas 25 subjects with normal kidney function had a decrease of the EDV with more than 20%. Anterior myocardial infarction was positively associated with LV remodeling due to the important extension of the territory irrigated by the anterior interventricular branch of the left coronary artery. Cardiac necrosis markers were positively associated with the infarct dimensions and their role in predicting an increase in the ventricular volume and LVEF reduction was significant. The ST segment resolution less than 70% after myocardial revascularization and a low myocardial blush or a decrease perfusion revealed on the angiography are other elements suitable for identifying the subjects with high risk of ventricular remodeling. Serum creatinine represented a marker of rapidly progressive LV remodeling. Conclusions: LV remodeling represents a serious condition and the prevention of the pathological process should be achieved through early myocardial revascularization. The markers used to assess the risk of the LV remodeling occurrence should be identified in every patient diagnosed with acute coronary syndrome. [ABSTRACT FROM AUTHOR]