Left ventricular dyssynchrony acutely after myocardial infarction predicts left ventricular remodeling.
OBJECTIVE
We sought to identify predictors of left ventricular (LV) remodeling after acute myocardial infarction.


BACKGROUND
Left ventricular remodeling after myocardial infarction is associated with an adverse long-term prognosis. Early identification of patients prone to LV remodeling is needed to optimize therapeutic management.


METHODS
A total of 178 consecutive patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention were included. Within 48 h of intervention, 2-dimensional echocardiography was performed to assess LV volumes, LV ejection fraction (LVEF), wall motion score index, left atrial dimension, E/E' ratio, and severity of mitral regurgitation. Left ventricular dyssynchrony was determined using speckle-tracking radial strain analysis. At 6-month follow-up, LV volumes, LVEF, and severity of mitral regurgitation were reassessed.


RESULTS
Patients showing LV remodeling at 6-month follow-up (20%) had comparable baseline characteristics to patients without LV remodeling (80%), except for higher peak troponin T levels (p < 0.001), peak creatine phosphokinase levels (p < 0.001), wall motion score index (p < 0.05), E/E' ratio (p < 0.05), and a larger extent of LV dyssynchrony (p < 0.001). Multivariable analysis demonstrated that LV dyssynchrony was superior in predicting LV remodeling. Receiver-operating characteristic curve analysis demonstrated that a cutoff value of 130 ms for LV dyssynchrony yields a sensitivity of 82% and a specificity of 95% to predict LV remodeling at 6-month follow-up.


CONCLUSIONS
Left ventricular dyssynchrony immediately after acute myocardial infarction predicts LV remodeling at 6-month follow-up.
Mollema
Sjoerd A
SA
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Liem
Su San
SS
Suffoletto
Matthew S
MS
Bleeker
Gabe B
GB
van der Hoeven
Bas L
BL
van de Veire
Nico R
NR
Boersma
Eric
E
Holman
Eduard R
ER
van der Wall
Ernst E
EE
Schalij
Martin J
MJ
Gorcsan
John
J
Bax
Jeroen J
JJ
D015906:Angioplasty, Balloon, Coronary; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D020107:Troponin T / Q000097:blood; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology*
D020107:Troponin T; D003402:Creatine Kinase