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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

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^_*, 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^_*,_*

^_* 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

Manuscript received November 30, 2006; revised manuscript received June 22, 2007, accepted July 12, 2007.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

Objectives: 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.

Abbreviations and Acronyms   2D = two-dimensional   E/E' = mitral inflow peak early velocity/mitral annular peak early velocity   LA = left atrium/atrial   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   WMSI = wall motion score index

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