title: Left ventricular dyssynchrony acutely after myocardial infarction predicts left ventricular remodeling.
abstract: 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.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sjoerd A
authors.initials: SA
authors.lastname: Mollema
authors.forename: Su San
authors.initials: SS
authors.lastname: Liem
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Suffoletto
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.forename: Bas L
authors.initials: BL
authors.lastname: van der Hoeven
authors.forename: Nico R
authors.initials: NR
authors.lastname: van de Veire
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: 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*
chemical_list: D020107:Troponin T; D003402:Creatine Kinase