Korean Circ J.  2009 Jun;39(6):236-242. 10.4070/kcj.2009.39.6.236.

Left Ventricular Dyssynchrony After Acute Myocardial Infarction is a Powerful Indicator of Left Ventricular Remodeling

• Ko JS
• Jeong MH
• Lee MG
• Lee SE
• Kang WY
• Kim SH
• Park KH
• Sim DS
• Yoon NS
• Yoon HJ
• Hong YJ
• Park HW
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 1490699
• DOI: http://doi.org/10.4070/kcj.2009.39.6.236

Abstract

BACKGROUND AND OBJECTIVES: Left ventricular (LV) remodeling (LVR) after an acute myocardial infarction (AMI) has important clinical implications. We have investigated the prognostic relevance of ventricular systolic dyssnchrony as an indicator of LVR after an AMI.
SUBJECTS AND METHODS
We enrolled 92 patients (males, 72.8%; mean age, 61.0+/-13.0 years) with an AMI who underwent successful percutaneous coronary intervention. We analyzed the baseline characteristics, the laboratory and echocardiographic findings, and we performed follow-up echocardiography 6 months after the AMI. The patients were divided into two groups: 1) the presence of LVR, which was defined as an increment of LV end systolic volume (LVESV) >20% compared with the baseline examination; and 2) the absence of LVR.
RESULTS
Twenty-seven patients (29.3%) developed LVR after a 6 month follow-up. There was no statistically significant difference in the clinical and angiographic findings between the two groups. With respect to the laboratory findings, the LVR group had a higher peak creatine kinase MB (CK-MB) (149.9+/-155.0 vs. 74.6+/-69.7 U/L, p=0.001) and troponin-I (70.2+/-73.3 vs. 43.2+/-39.5 ng/mL, p=0.024) level than the group without LVR. With respect to echocardiographic findings, the baseline LV ejection fraction (EF) and LVESV were not significantly different (LVESV, 73.0+/-37.3 vs. 91.3+/-52.0 mL, p=0.013; and EF, 58.3+/-13.3 vs. 55.6+/-11.8%, p=0.329) between the groups with and without LVR, respectively. The degree of LV dyssynchrony, which was assessed by tissue Doppler imaging, was significantly higher in the LVR group than the group without LVR (75.2+/-43.4 vs. 38.3+/-32.5 ms), and the degree of LV dyssynchrony was an independent predictor for LVR based on multivariate analysis {hazard ratio (HR)=0.097, p<0.001}. In receiver operating characteristics (ROC) curve analysis, the area under the curve (AUC) was 0.754 and a cutoff value of 45.9 predicted the development of LVR with 74.1% sensitivity and 72.3% specificity.
CONCLUSION
The presence of LV dyssynchroncy immediately after a myocardial infarction is an important predictive factor for development LVR.

Keyword

Ventricular remodeling; Myocardial infarction; Dyssynchrony

MeSH Terms

Creatine Kinase
Echocardiography
Follow-Up Studies
Humans
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention
ROC Curve
Sensitivity and Specificity
Troponin I
Ventricular Remodeling
Creatine Kinase
Troponin I

Figure

• 

  Fig. 1 Individual value of LV dyssynchrony index according to LV remodeling. Plotting of maximum difference in time to peak systolic time (Ts-diff.) showed a significantly higher mean value in the LV remodeling group. LV: left ventride, Ts-diff.: maximum difference between time to peak systolic velocity.

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  Fig. 2 Correlation between LV dyssynchrony index and change in LVESV. This figure showed a positive correlation between LVESV and the dyssynchrony index (r2=0.111, p=0.001). LVESV: left ventricular end systolic volume, Ts-diff.: maximum difference between time to peak systolic velocity.

• 

  Fig. 3 Receiver operating characteristics (ROC) curve of LV dyssynchrony index. Area under curve (AUC) was 0.754, which indicates good predictability. The value, 45.9 ms, predicted development of LV remodeling with a sensitivity of 74.1% and a specificity of 72.3%. LV: left ventricle.

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