Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI

Wita, Krystian; Filipecki, Artur; Lelek, Michał; Bochenek, Tomasz; Elżbieciak, Marek; Wróbel, Wojciech; Kucza, Adrianna Berger; Tabor, Z.; Drzewiecki, J; Grabka, Marek; Gluza, Maria Trusz

doi:10.1097/mca.0b013e328343fbe1

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…Most, but not all, patients with LVR had STEMI (60%), though NSTEMI diagnosis does not exclude transmural infarction. There are also findings other than LV volume or echocardiographic EF suggesting increased risk of LVR, including: significant diastolic dysfunction [ 20 ], restrictive mitral filling [ 29 ], LV dyssynchrony [ 30 ] and myocardial perfusion in contrast-enhanced echocardiography [ 31 ]. Mitral valve regurgitation is common in patients with MI (15–64%), constitutes an independent risk factor for cardiovascular mortality, and may be a predictive risk factor or even may accelerate LVR [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Liszka¹,

Haberka²,

Tabor³

et al. 2014

aoms

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IntroductionLeft ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).Material and methodsEighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.ResultsAt initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. –11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR– group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (–15.58 ±8.9% vs. –25.53 ±8.8%, p < 0.001; –15.02 ±5.6 vs. –19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (–8.7 ±5.8% vs. –13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR– group. According to ROC analysis, circumferential apical strain > –15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.ConclusionsOur results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients’ follow-up.

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Section: Discussionmentioning

confidence: 99%

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Liszka¹,

Haberka²,

Tabor³

et al. 2014

aoms

Self Cite

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“…However, detailed studies have shown that up to 25% of patients undergoing angioplasty lack myocardial reperfusion despite revascularization of the infarct-related artery 9. As a result, cardiac mortality remains high, particularly in patients who develop heart failure.…”

Section: Discussionmentioning

confidence: 99%

Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

et al. 2014

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PurposeCoronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI.Materials and MethodsWe enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration.ResultsCFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p<0.01) at one week following AMI. According to CFR values in the remote zone, all patients were divided into two groups: Group I (CFR <2.05) and Group II (CFR >2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty.ConclusionMicrovascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

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“…Quantitative MCE represents a useful tool for the prediction of cardiac remodeling after STEMI [55]. Specifically parameters of contrast intensity (A, , x ) exhibited an excellent sensitivity in predicting heart remodeling within 6-month interval after myocardial infarction.…”

Section: Acute Coronary Syndromesmentioning

confidence: 99%

Contrast Echocardiography: An Update on Clinical Applications

Aggeli

Felekos²,

Tsiamis³

et al. 2012

CPD

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Contrast echocardiography is considered by many as the Holy Grail for the assessment of heart disease, including coronary artery disease, structural abnormalities and cardiomyopathies. Although contrast agents have been severely criticized at times, they are now officially implemented into an extended variety of clinical applications, as illustrated by the American and European echocardiographic societies published consensus statements. The current review highlights contrast major clinical applications under the light of current literature data.

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Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI

Cited by 13 publications

References 24 publications

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Coronary Flow Reserve in the Remote Myocardium Predicts Left Ventricular Remodeling Following Acute Myocardial Infarction

Contrast Echocardiography: An Update on Clinical Applications

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