Effect of various factors on cardiac remodeling and dysfunction

Objective To evaluate the effects of different styles of coronary heart disease (CHD) and different regions of acute myocardial infarction (AMI), its risk factors and branches of coronary stenosis on left ventricular remodeling and systolic function by applying echocardiography. Methods 251 patients with CHD and 96 without CHD (NoCHD) were verified by coronary angiography. CHD patients were divided into SA (stable angina pectoris, n =26), UA (unstable angina pectoris, n =53), AMI ( n =140) and OMI (old myocardial infarct, n =30) based on cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including Aa (acute anterior myocardial infarct, n =53), Ai (acute inferior myocardial infarct, n =54) and Aa+Ai ( n =33) based on ECG. Cardiac parameters [IVSd (end diastolic interventricular septum thickness), LVd (end diastolic left ventricular internal diameter), LM (left ventricular mass), EDV (end diastolic left ventricular volume), ESV (end systolic left ventricular volume) and EF (left ventricular ejection fraction)] were measured by ACUSON 128XP/10 echocardiography. The effluence of the involved branches of coronary stenosis, blood pressure, blood lipids, glucose and etc on LVEF and LVd was analyzed in patients with AMI. Results EDV, ESV and EF in patient with AMI, OMI and UA were significantly changed ( P 0 05～0 0001), especially in those with AMI. LM was mainly increased in patients with OMI ( P 0 01) and LVd was mainly increased in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in patients with Aa and Aa+Ai. With the multiple regression analysis by SPSS software, we found the branches of involved coronary stenosis and systolic blood pressure after AMI were negatively related to LVEF in patients with AMI, while there was no significant relationship between other factors and LVEF. LVEF was significantly decreased, and LVd and LM were remarkably increased in patients with hypertension before AMI, compared to patients without hypertension ( P 0 001). Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction is one of the most important causes of left ventricular remodeling and cardiac dysfunction, especially in AMI patients with Aa and Aa+Ai. Multiple vessel stenosis and systolic blood pressure mainly affected LVEF in patients with AMI, reduced LVEF. Antecedent hypertension might be a main reason of bringing about cardiac remodeling and dysfunction.