Myocardial-adrenoceptor down-regulation early after infarction is associated with long-term incidence of congestive heart failure

Aims Adverse left ventricular (LV) remodelling after myocardial infarction (MI) frequently leads to congestive heart failure (CHF). We have previously shown that myocardial-adrenoceptor density (-ARD) is reduced soon after acute MI and correlates with LV dilatation in the short term. The aim of the present study was to determine whether myocardial-ARD measured early after MI was associated with progression to CHF in the long term.Methods and resultsWe prospectively included 61 consecutive patients (mean age, 52 ± 11 years, 10 female) in whom MI was the first manifestation of coronary artery disease. Two to 4 weeks after MI, patients underwent positron emission tomography with S-[¹¹C]CGP 12177 to measure-ARD and ¹⁵O-labelled water to measure myocardial blood flow and coronary flow reserve. Patients were followed-up for a median of 12.7 years (interquartile range, 6.5-13.7 years) and incidence of CHF was recorded. Eleven patients (18) developed CHF during follow-up. They had lower-ARD compared with those who did not (5.35 vs. 6.49 pmol/g, P <0.001). In patients with myocardial-ARD ≤5.57 pmol/g, 10-year CHF incidence rates were higher than in patients with-ARD >5.57 pmol/g (57 vs. 9, P <0.001). In a Cox regression model, only whole-heart-ARD [hazard ratio (HR) 0.29; 95 confidence interval (CI), 0.15-0.58, P <0.001] and-ARD in remote myocardium (HR 0.32; 95 CI, 0.16-0.61, P = 0.001) were significantly associated with the incidence of CHF at follow-up. Conclusion Reduced myocardial-ARD early after MI is associated with the incidence of CHF on long-term follow-up.