Beneficial effect of ischemic preconditioning on post-infarction left ventricular remodeling and global left ventricular function Christodoulos E. Papadopoulos a, ⁎ , Dimitrios G. Zioutas a , Georgios A. Giannakoulas a , Sotirios Matsiras b , Theodoros D. Karamitsos a , Haralambos I. Karvounis a , Paraschos Geleris c , Ioannis Stiliadis a a 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece b Halastra HC, Agios Dimitrios General Hospital, Thessaloniki, Greece c 2nd Propedeutic Department of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Greece Received 12 July 2010; received in revised form 15 November 2010; accepted 23 November 2010 Abstract Background: Preinfarction angina (PA) is a clinical analogue of ischemic preconditioning that improves postinfarct prognosis. Data concerning the association of PA with post infarction left ventricular (LV) remodeling and LV diastolic function are limited. We aimed to evaluate this association in patients with acute myocardial infarction (AMI) in the modern clinical era of widespread use of revascularization and antiremodeling medical treatment. Methods: We studied 53 patients with anterior AMI who underwent complete reperfusion and received up to date antiremodeling medical treatment. LV remodeling, systolic and diastolic function were assessed using 2D echocardiography at baseline and 6 at months follow-up. Patients were divided into two groups regarding the presence or absence of PA. Results: LV remodeling at follow-up was less frequent in the PA group (25 vs. 55 %, Pb.05). Patients with PA had lower end-systolic volume index at baseline and follow up (24.1±6 vs. 30.1±14 ml/m 2 , Pb.001 and 25.3±8 vs. 35.6±2 ml/m 2 , P=.001 respectively). Additionally at 6 months, they had better LV ejection fraction (52.1±9 vs. 42.9±10 %, P=.002) and exhibited improved diastolic filling as reflected by mitral E/e′ (14.6±5 vs. 18.8±8, P=.05). Conclusions: Ischemic preconditioning in the form of PA promotes better LV systolic and diastolic function in the mid-term and is associated with less postinfarct LV remodeling in this specific study population. The results of the study underline the possible need for further risk stratification of AMI patients regarding the absence of PA. © 2011 Elsevier Inc. All rights reserved. Keywords: Preconditioning; Infarction; Revascularization; Remodeling; Diastolic filling 1. Summary We aimed to investigate the possible association of preinfarction angina (PA) and left ventricular (LV) remodel- ing and LV performance 6 months following an acute anterior wall myocardial infarction. Patients with PA experienced less severe LV remodeling while they exhibited better LV systolic function and improved LV diastolic filling properties. Ischemic preconditioning, first described 2 decades ago [1], has been considered as the most efficient intervention to reduce infarct size other than reperfusion [2]. Today there is clear evidence that this phenomenon occurs in humans and one of the most relevant clinical counterparts include preinfarction angina (PA) [3] Numerous studies have shown that the presence of angina in a variable time period before the acute presentation of myocardial infarction (AMI) Cardiovascular Revascularization Medicine 12 (2011) 286 – 291 ⁎ Corresponding author. CE Papadopoulos, Egnatias 95 Str, 54635, Thessaloniki, Greece. Tel.: +30 2310 223330; fax: +30 2310 223330. E-mail address: chpapado@auth.gr (C.E. Papadopoulos). 1553-8389/10/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.carrev.2010.11.005