Background: Infarct expansion is associated with impaired borderzone function, adverse remodeling, and poor long-term prognosis. We hypothesized that left ventricular restraint early after myocardial infarction limits infarct expansion, preserves borderzone function, and reduces remodeling.
Methods: We used an ovine model as well as high spatial and temporal resolution cardiac magnetic resonance imaging to quantify total and infarcted left ventricular epicardial surface area at baseline and 1 week and 12 weeks after anterior wall infarction in 10 animals. Five animals were randomly assigned to treatment with left ventricular restraint (Acorn cardiac support device) 1 week after infarction. Five animals were untreated controls. Total left ventricular surface area was measured by importing the end-diastolic magnetic resonance imaging-derived epicardial contours into custom software, which creates a three-dimensional surface from the two-dimensional magnetic resonance imaging contours. Infarct area was calculated from magnetic resonance imaging-detectable titanium markers placed at the infarct border. Borderzone radial and circumferential strains during systole were also assessed using myocardial tagging techniques as a measure of contractile function.
Results: The infarct area 1 week after infarction was 1,177 +/- 386 mm(2) in the control group and 1,124 +/- 427 mm(2) in the cardiac support device group. After 12 weeks, infarct area was 3,666 +/- 1,013 mm(2) in the control group and 1,227 +/- 301 mm(2) in the cardiac support device group. Borderzone systolic radial strain decreased from 12.6% +/- 0.77% to 3.6% +/- 0.3% after infarction in the control group and 13.7% +/- 0.87% to 4.7% +/- 0.3% in the cardiac support device group. At 12 weeks after infarction, radial strain was 3.4% +/- 0.5% in the control group and 6.7% +/- 0.4% in the cardiac support device group.
Conclusions: Early postinfarction left ventricular restraint limits infarct expansion and improves borderzone contractile function.
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