Regional wall stress predicts ventricular remodeling after anteroseptal myocardial infarction in the Healing and Early Afterload Reducing Trial (HEART): An echocardiography-based structural analysis

Background Increased left ventricular (IV) wall stress after myocardial inf arction (MI) has been implicated in LV remodeling. However, the relationshi p between LV wall stress and IV remodeling is incompletely defined. Method We prospectively studied the relationship between regional wall stre ss and LV remodeling by application of the finite element method to end-sys tolic LV models from patients enrolled in the Healing and Early Afterload R educing Therapy (HEART) Trial. individual LV models were constructed from o rthogonal apical echocardiographic views obtained at day 14 after anterosep tal Mi in 64 patients. Of these, 31 patients received low-dose (0.625 mg) r amipril and 33 patients received full-dose (10 mg) ramipril. LV wall stress was calculated by the finite element method and correlated with change in LV volume from day 14 to day 90 after MI. Results Among all patients, increases in apical regional wall stress were a ssociated with LV volume changes (P-trend = .015), The relationship between apical regional wall stress and change in LV volume wets strongest in the low-dose ramipril group (r = 0.53, P = .002) and remained significant after adjustment for end-diastolic volume, infarct size, election fraction, and systolic blood pressure yet was attenuated in the full-dose ramipril group. Conclusions. Apical regional wall stress is an independent predictor of sub sequent LV remodeling after MI. The relationship between increased apical w all stress and IV dilatation appears to be attenuated by full-dose angioten sin-converting enzyme inhibition.