Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling
Sjoerd A. Mollema, MD*,
Su San Liem, MD*,
Matthew S. Suffoletto, MD ,
Gabe B. Bleeker, MD*,2,
Bas L. van der Hoeven, MD*,
Nico R. van de Veire, MD, PhD*,
Eric Boersma, PhD ,
Eduard R. Holman, MD, PhD*,
Ernst E. van der Wall, MD, PhD*,
Martin J. Schalij, MD, PhD*,
John Gorcsan, III, MD and
Jeroen J. Bax, MD, PhD*,1,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
The Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Figure 1 Extent of LV Dyssynchrony Was Significantly Larger in Patients With LV Remodeling During Follow-Up Versus Those Without LV Remodeling
Left panel demonstrates time-strain curves of a patient without dyssynchrony at baseline. This patient did not show left ventricular (LV) remodeling during follow-up (left ventricular end-systolic volume [LVESV] was 84 vs. 73 ml, baseline vs. 6-month follow-up). Right panel demonstrates time-strain curves of a patient with LV dyssynchrony at baseline (earliest activated segments: purple, green, and dark-blue, latest activated segments: light-blue, yellow, and red). This patient showed LV remodeling during follow-up (LVESV was 77 vs. 122 ml, baseline vs. 6-month follow-up).
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Figure 2 LV Dyssynchrony in Patients Without Versus With LV Remodeling at 6-Month Follow-Up
Box-whisker plot indicates median, first quartile, third quartile, and range. Median left ventricular (LV) dyssynchrony was significantly higher (p < 0.001) in the patients with LV remodeling versus without LV remodeling (148 ms [134, 180 ms] vs. 31 ms [12, 77 ms], respectively).
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Figure 3 Distribution of Latest Activated LV Segments in Patients With LV Remodeling
According to the high prevalence of the left anterior descending coronary artery (LAD) as infarct-related artery, the anteroseptal and septal left ventricular (LV) segments are activated late in a considerable proportion of the patients with LV remodeling.
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Figure 4 Correlation Between LV Dyssynchrony at Baseline and LVESV and Change in LVESV at 6-Month Follow-Up
A significant relation existed between baseline left ventricular (LV) dyssynchrony and absolute value for left ventricular end-systolic volume (LVESV) (left panel) and change in LVESV (right panel) at follow-up.
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Figure 5 The Extent of LV Dyssynchrony According to Changes in LVESV During Follow-Up
Of note, the extent of left ventricular (LV) dyssynchrony was largest in patients with significant LV remodeling (increase in left ventricular end-systolic volume [LVESV]  15%). ESV = end-systolic volume.
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Figure 6 ROC Curve Analysis to Determine the Optimal Cutoff Value for LV Dyssynchrony to Predict LV Remodeling
Using a cutoff value of 130 ms, a sensitivity of 82% and a specificity of 95% were obtained to predict left ventricular (LV) remodeling. ROC = receiver-operating characteristic.
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