Echocardiography to understand remodeling and to assess prognosis after acute myocardial infarction

Ventricular remodeling indicates a dynamic process, starting with and after acute myocardial infarction, as a result of structural and functional modifications which involve acutely and chronically both the infarcted and noninfarcted zones of the left ventricle. The most effective way to prevent or minimize post-MI cardiac remodeling is to limit the extent of the initial insult. This can be partly achieved by early myocardial reperfusion obtained by different strategies including thrombolysis. In 6405 patients of the GISSI-3 trial, 2D echocardiographic studies were available at predischarge, at 6 weeks and at 6 months after the infarction. The increase in left ventricular volumes over time was reduced by 6-week lisinopril treatment. Patients randomized to lisinopril had smaller volume also at 6 months, after withdrawal of treatment at 6 weeks. Important prognostic indications can also be derived from predischarge echocardiography, since larger quartiles of left ventricular volumes and lower quartile of ejection fraction indicates higher risk of mortality and non-fatal congestive heart failure in the 6 months after the index event, even in the relatively low risk general population of infarcts of the GISSI-3.