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(Circulation Research. 2008;103:1.)
© 2008 American Heart Association, Inc.

Editorials

New Insights Into the Open Artery Hypothesis

Robert A. Kloner, Hyosook Hwang

From the Heart Institute (R.A.K., H.H.), Good Samaritan Hospital, and the Division of Cardiovascular Medicine (R.A.K.), Keck School of Medicine, University of Southern California, Los Angeles.

Correspondence to Robert A. Kloner, MD, PhD, Heart Institute, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, CA 90017. E-mail rkloner@goodsam.org

See related article, pages 98–106

Key Words: myocardial infarction • infarct expansion • ventricular remodeling • ventricular dilation • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Factors Affecting Left Ventricular Remodeling

 
Early coronary artery reperfusion is clearly the most important therapy for acute ST segment elevation myocardial infarcts. Early reperfusion reduces myocardial infarct size and in so doing helps to prevent or minimize deleterious consequences of a large myocardial infarction, including infarct expansion (thinning and dilation of the infarct), subsequent eccentric hypertrophy and dilation of the noninfarcted ventricular muscle, and global dilation of the left ventricle.^1–4 These processes encompass the phenomenon of ventricular remodeling. One of the major determinants of death at 1 year after a myocardial infarction is the degree of dilation of the left ventricle (LV).⁵ However, suppose early reperfusion is not available. A number of manipulations and pharmacological therapies can be administered beyond the time frame of reducing myocardial infarct size and still reduce the extent of infarct expansion and LV remodeling (Table 1). Angiotensin converting enzyme inhibitors⁶ and angiotensin receptor blockers⁷ have been shown to reduce LV dilation and remodeling and in some studies reduce major cardiovascular events. Cell therapy and even some noncellular therapies (collagen, alginate) may thicken the infarct scar and prevent ventricular wall dyskinesis.^8–10 Aneurysmectomy and certain suturing techniques have been attempted to prevent infarct expansion and remodeling.¹¹ Late reperfusion—too late to reduce myocardial infarct size, but early enough to favorably affect infarct healing¹—also appears to limit infarct expansion and limit LV remodeling, and is the subject of the accompanying article.¹²

View this table:   Table 1. Table 1. Factors That May Improve or Lessen Post-MI LV Remodeling

Certain features are associated with worse LV remodeling (. . . [Full Text of this Article]

Related Article:

Mechanisms by Which Late Coronary Reperfusion Mitigates Postinfarction Cardiac Remodeling

Munehiro Nakagawa, Genzou Takemura, Hiromitsu Kanamori, Kazuko Goto, Rumi Maruyama, Akiko Tsujimoto, Takamasa Ohno, Hideshi Okada, Atsushi Ogino, Masayasu Esaki, Shusaku Miyata, Longhu Li, Hiroaki Ushikoshi, Takuma Aoyama, Masanori Kawasaki, Kenshi Nagashima, Takako Fujiwara, Shinya Minatoguchi, and Hisayoshi Fujiwara
Circ. Res. 2008 103: 98-106. [Abstract] [Full Text] [PDF]

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