Recruitment of Ventricular Function with Adjunctive Nitrate Therapy after Late Reperfusion
Late reperfusion in acute myocardial infarction (MI) is associated with myocardial stunning and delayed functional recovery. Adjunctive nitrate therapy is of potential value in the short term, during late reperfusion, and throughout the healing process after MI for recruitment of left ventricular function and preservation of geometry.
Left ventricular function and geometry after acute myocardial infarction (MI) are major determinants of outcome [1,2]. Late coronary artery reperfusion in acute MI is associated with reperfusion injury, myocardial stunning, and delayed recovery of function . Thus, reperfusion after 2hr of coronary occlusion in dogs results in partial recovery of function over 2–6 weeks [4–6]. However, late reperfusion can still preserve geometry and limit infarct expansion in dogs , even in the absence of myocardial salvage
Early recruitment of left ventricular function after late reperfusion in MI with adjunctive therapy might be possible and improve outcome. Experimental and clinical evidence suggest that nitrates might be candidates for such adjunctive therapy. Thus, short-term intravenous nitroglycerin infusion, begun up to 14hr after acute MI in patients, has been shown to produce prompt and persistent improvement in function [10–12] and attenuation of left ventricular remodeling [11,12]. Furthermore, prolonged nitrate therapy after anterior infarction preserves function and limits remodeling in dogs [13,14] and patients [15,16]. In several large trials, about 50% of patients with MI received nitrates during reperfusion therapy with thrombolytic agents [17–21]. However, there has been no systematic evaluation of adjunc-tive nitrate therapy after late reperfusion in animals or humans to date.
KeywordsAcute Myocardial Infarction Left Ventricular Function Left Ventricular Remodel Myocardial Stunning Myocardial Salvage
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