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Detection of Left Ventricular Remodeling in Acute ST Elevation Myocardial Infarction after Primary Percutaneous

Rakesh Kumar Ola1, Chandra Bhan Meena1, S Ramakrishnan2

  • 1Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.

Journal of Cardiovascular Echography
|April 10, 2018
PubMed

Insights

Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) impacts prognosis. Three-dimensional echocardiography (3DE) and 3D sphericity index (SI) can accurately predict LVR development early after STEMI.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Left ventricular remodeling (LVR) following ST-elevation myocardial infarction (STEMI) is linked to adverse outcomes.
  • Three-dimensional echocardiography (3DE) offers superior accuracy in assessing left ventricle (LV) geometry compared to 2D echocardiography.
  • Primary angioplasty is a common intervention for STEMI patients.

Purpose of the Study:

  • To evaluate left ventricular (LV) geometry using 3D echocardiography (3DE) six months after STEMI in patients who underwent primary angioplasty.
  • To identify predictors of LVR development in the post-STEMI period.

Main Methods:

  • A prospective study involving 42 STEMI patients who underwent primary angioplasty.
  • Morphological and functional LV analysis using 3DE, including volumes, ejection fraction (LVEF), and 3D sphericity index (SI), was performed at 7 days and 6 months post-STEMI.
  • LVR was defined as a >15% increase in end-diastolic volume (LVEDV) at 6 months compared to baseline (7 days).

Main Results:

  • Left ventricular remodeling (LVR) was observed in 38% of patients at 6 months post-STEMI.
  • Patients who developed LVR exhibited significantly higher baseline LVEDV, lower LVEF, and lower 3D sphericity index (SI) at 7 days compared to those without LVR.
  • At 6 months, LVR patients had increased LVEDV and decreased LVEF, with a significantly lower 3D SI compared to the no-remodeling group.

Conclusions:

  • Left ventricular remodeling (LVR) occurs in a significant proportion of STEMI patients within six months.
  • The 3D sphericity index (SI) measured by 3DE is a valuable early indicator that can accurately differentiate patients who will develop LVR.
  • Early assessment of LV geometry with 3DE, particularly 3D SI, may aid in identifying patients at risk for LVR after STEMI.
Abstract

Keywords:
Left ventricular remodelingthree-dimensional echocardiographythree-dimensional sphericity index

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