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J Am Coll Cardiol 2007;50:1532-40

Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling. J Am Coll Cardiol 2007;50:1532-40.

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J Am Coll Cardiol 2007;50:1532-40

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  1. Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling J Am Coll Cardiol 2007;50:1532-40 Sjoerd A. Mollema1, Su San Liem1, Matthew S. Suffoletto3, Gabe B. Bleeker1, Bas L. van der Hoeven1, Nico R. van de Veire1, Eric Boersma2, Eduard R. Holman1, Ernst E. van der Wall1, Martin J. Schalij1, John Gorcsan III3, Jeroen J. Bax1 1LUMC (Cardiology), Leiden, The Netherlands 2Erasmus MC (Statistics), Rotterdam, The Netherlands 3The Cardiovascular Institute, Pittsburgh, USA

  2. Introduction • LV remodeling after AMI → adverse long-term prognosis1 • Early identification → optimize therapeutic management • Early identification: baseline predictor 1 White et al, Circulation 1987; 76(1): 44-51

  3. Objectives • To identify baseline predictors of long-term LV remodeling after acute myocardial infarction • Early identification of patients prone to LV remodeling in order to optimize therapeutic management

  4. Methods • All patients (n=178) underwent primary PCI for acute myocardial infarction • 2D-Echocardiography was performed <48 h of admission & at 6 month FUP LV dyssynchrony was quantified using speckle-tracking radial strain analysis. Time-strain curves of a patient without (left panel) and with (right panel) dyssynchrony at baseline are demonstrated.

  5. Results Median LV dyssynchrony was significantly higher (p <0.001) in patients with LV remodeling versus without LV remodeling.

  6. Results Distribution of latest activated LV segments in patients with LV remodeling.

  7. Results Correlation between LV dyssynchrony at baseline and LV end-systolic volume (left panel) and change in LV end-systolic volume (right panel) at 6-month FUP.

  8. Results Extent of LV dyssynchrony according to changes in LV end-systolic volume during FUP.

  9. Results ROC curve analysis to determine the optimal cutoff value for LV dyssynchrony to predict LV remodeling.

  10. Conclusions • Patients with LV remodeling demonstrate: - ↑ baseline peak levels of cardiac enzymes - ↑ WMSI - ↑ E/E’ ratio - ↑ extent of LV dyssynchrony • Baseline LV dyssynchrony of ≥130 ms → sensitivity of 82% and specificity of 95% to predict LV remodeling at 6 months after AMI • Optimization of therapeutic management in patients with severe LV dyssynchrony early after AMI might be beneficial: - further pharmacologic optimization? - early use of CRT?

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