Author + information
- Received November 30, 2006
- Revision received June 22, 2007
- Accepted July 12, 2007
- Published online October 16, 2007.
- 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,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
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.
↵1 Dr. Bax receives research grants from GE Healthcare (Chalfont St. Giles, United Kingdom).
↵2 Dr. Bleeker receives a grant from the Netherlands Heart Foundation (NHS2002B109), The Hague, the Netherlands.
This study was supported by an unrestricted research grant from St. Jude Medical.
See accompanying online Cardiosource Slide Set.
- Received November 30, 2006.
- Revision received June 22, 2007.
- Accepted July 12, 2007.
- American College of Cardiology Foundation