title: Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion.
abstract: Reverse left ventricular (LV) remodeling (>10 % reduction in LV end-systolic volume) may occur in patients recovering for acute ST-elevation myocardial infarction (STEMI), undergoing percutaneous revascularization of infarct-related coronary artery (PCI). To detect whether LV global torsion obtained by two-dimensional speckle-tracking echocardiography was predictive of reverse LV remodeling, 75 patients with first anterior wall STEMI were studied before (T1) and after PCI (T2) and at 6-month follow-up. Two-year clinical follow-up was also accomplished. LV volumes and both LV sphericity index and conic index were obtained by three-dimensional echocardiography. Reverse remodeling was observed in 25 patients (33 %). By multivariate analysis, independent predictors of reverse LV remodeling were: LV conic index, T2 LV torsion and Δ torsion (difference between T2 and T1 LV torsion expressed as percentage of this latter). According to receiver operating characteristic analysis, 1.34°/cm for T2 LV torsion (sensitivity 88 % and specificity 80 %) and 54 % for Δ torsion (sensitivity 92 % and specificity 82 %) were the optimal cutoff values in predicting reverse LV remodeling. In up to 24 month follow-up, 4 non-fatal re-infarction, 7 hospitalization for heart failure and 4 cardiac deaths occurred. By multivariate Cox analysis, the best variable significantly associated with event-free survival rate was reverse LV remodeling with a hazard ratio = 9.9 (95 % confidence interval, 7.9-31.4, p < 0.01). In conclusion, reverse LV remodeling occurring after anterior wall STEMI is associated with favorable long-term outcome. The improvement of global LV torsion following coronary artery revascularization is the major predictor of reverse LV remodeling.
authors.affiliation: Department of Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy. letspine@unina.it
authors.forename: Letizia
authors.initials: L
authors.lastname: Spinelli
authors.forename: Carmine
authors.initials: C
authors.lastname: Morisco
authors.forename: Emiliano
authors.initials: E
authors.lastname: Assante di Panzillo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
mesh_terms: D000328:Adult; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D013997:Time Factors; D054159:Torsion, Mechanical; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling