Functional impact of remodeling during healing after non-Q wave versus Q wave anterior myocardial infarction in the dog

Abstract

Objectives: This study was undertaken to compare changes in left ventricular remodeling and function during healing after a first anterior non-Q wave versus a Q wave myocardial infarction in the dog.

Background: Whether ventricular remodeling is more severe after anterior Q wave than after anterior non-Q wave infarction has not been studied systematically.

Methods: Serial remodeling and functional variables (two-dimensional echocardiography), electrocardiography and hemodynamic data were recorded over 6 weeks in 58 instrumented dogs subjected to left anterior descending coronary artery ligation or ligation plus collateral obliteration. Postmortem topography and transmurality (by planimetry) and infarct collagen (hydroxyproline) were measured at 6 weeks.

Results: At 6 weeks, infarct collagen was similarly increased in both groups, but the Q wave group had greater infarct size (7.2% vs. 4.5%, p less than 0.025) and greater transmurality (88% vs. 58%, p less than 0.001), higher left atrial pressures, more infarct expansion (expansion index 2.62 vs. 2.31, p less than 0.001), more thinning (thinning ratio 0.62 vs. 0.72, p less than 0.001), greater cavity dilation (diastolic volume 88 vs. 72 ml, p less than 0.001), more regional bulging in the short-axis view (depth 4.9 vs. 1.9 mm, p less than 0.001), more regional asynergy (18% vs. 7%, p less than 0.001), lower global ejection fraction (40% vs. 48%, p less than 0.001), more endocardial and epicardial bulging in the long-axis view and greater incidence of aneurysm (82% vs. 36%, p less than 0.005), left ventricular thrombus (64% vs. 0%, p less than 0.0005) and ventricular arrhythmias. Echocardiograms obtained during a 6-week period indicated that left ventricular topographic deterioration and dysfunction were present in the earliest postinfarction study at 2 days in both groups but were more frequent in the Q wave group. Regional myocardial blood flow (24 dogs) was lower in the Q wave than in the non-Q wave group. Scanning electron microscopy (10 dogs) revealed preservation of the epicardial collagen matrix in the non-Q wave but not the Q wave group.

Conclusions: Anterior Q wave infarction is associated with greater transmurality and more postinfarction left ventricular remodeling and dysfunction than is non-Q wave infarction.