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Early changes in left ventricular volume and function are predictors for long-term remodeling in patients with acute
Torstein Hole1, Johnny Age Vegsundvåg, Torstein Holm Morstøl
1Section of Cardiology, Medical Department, Alesund Hospital, N-6026 Alesund, Norway. torstein.hole@helse-sunnmore.no
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In patients with myocardial infarction and preserved ejection fraction, 12% experienced significant left ventricular dilation within 2 years. Early Doppler echocardiography can help predict this long-term remodeling process.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Assessing long-term left ventricular (LV) remodeling after acute myocardial infarction (MI) in patients with preserved systolic function.
- Evaluating the predictive value of early Doppler echocardiographic parameters for LV remodeling post-MI.
Purpose of the Study:
- To describe the extent of long-term LV remodeling after acute transmural myocardial infarction (MI) in patients with preserved LV systolic function.
- To determine if early Doppler echocardiographic parameters can predict this remodeling process.
Main Methods:
- Follow-up of 60 patients post-MI without heart failure and with LV ejection fraction >= 0.40.
- Doppler echocardiographic examinations at baseline, 3 months, 1 year, and 2 years.
Main Results:
- A significant increase in LV end-diastolic volume index (7%) and LV end-systolic volume index (8%) was observed, with no change in ejection fraction.
- Significant LV remodeling (LV end-diastolic volume index increase > 20 mL/m(2)) occurred in 12% of patients over 2 years.
- Early mitral filling wave deceleration time and pulmonary venous flow deceleration time increased, indicating diastolic dysfunction; baseline early mitral filling wave < 100 ms predicted changes in end-diastolic volume index, with 3-month volume changes being the strongest predictors of 2-year remodeling.
Conclusions:
- 12% of patients with Q-wave infarction and preserved ejection fraction (> or = 0.40) showed significant LV dilatation at 2 years.
- Late LV remodeling after MI is partly associated with baseline diastolic filling characteristics.
- Doppler echocardiography parameters in the early phase can offer insights into predicting long-term LV remodeling.
Background:
We sought to describe the degree of long-term left ventricular (LV) remodeling after acute transmural myocardial infarction with preserved LV systolic function, and to evaluate whether Doppler echocardiographic parameters in the early phase could predict this process.
Methods:
A total of 60 patients without heart failure and with LV ejection fraction > or = 0.40 (mean 0.48 +/- 0.054), were followed up with Doppler echocardiographic examinations at baseline, 3 months, and 1 and 2 years.
Results:
There was a significant increase in LV end-diastolic volume index of 7% (P =.006) and LV end-systolic volume index of 8% (P =.03), and no change in ejection fraction. This remodeling was confined to 7 patients (12%) with a significant increase in LV end-diastolic volume index above 20 mL/m(2). There was also a significant increase in the deceleration time of both the early mitral filling wave (Delta early mitral filling wave = 58 milliseconds, P <.0005) and the diastolic forward component of pulmonary venous flow (Delta diastolic forward component of pulmonary venous flow = 61 milliseconds, P <.0005), and a shift in filling pattern with increasing prevalence of abnormal relaxation. Changes in end-diastolic volume index were predicted by baseline early mitral filling wave less than 100 milliseconds, but the most powerful predictors of 2-year remodeling were volume changes at 3 months.
Conclusion:
Twelve percent of patients with Q-wave infarction and ejection fraction > or = 0.40 experienced significant LV dilatation at 2 years, and this late remodeling was partly related to baseline filling characteristics.