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Myocardial Mechanical Dispersion Predicts Adverse Cardiac Remodeling in Patients with ST Segment Elevation Myocardial
Olga Petyunina1, Mykola Kopytsya1, Alla Kobets1
1Department of prevention and treatment of emergency conditions, L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Ukraine.
Insights
Increased left ventricular mechanical dispersion predicts adverse cardiac remodeling in ST-elevation myocardial infarction patients after PCI. This finding aids in identifying high-risk individuals for better prognosis and management.
Area of Science:
- Cardiology
- Cardiac Imaging
- Biomarkers
Background:
- Adverse cardiac remodeling is a significant complication following ST-segment elevation myocardial infarction (STEMI).
- Early identification of patients at risk for adverse remodeling is crucial for timely intervention.
- Left ventricular mechanical dispersion (LVMD) is a potential, yet understudied, predictor of cardiac outcomes.
Purpose of the Study:
- To investigate if increased left ventricular mechanical dispersion (LVMD) serves as an early predictor of adverse cardiac remodeling.
- To assess LVMD in ST-elevation myocardial infarction (STEMI) patients with successful reperfusion (TIMI flow grade > 2) post-percutaneous coronary intervention (PCI).
Main Methods:
- 119 STEMI patients with TIMI flow grade > 2 post-PCI were prospectively enrolled.
- Left ventricular global longitudinal strain (LVGLS) and LVMD were assessed using 2D speckle-tracking echocardiography at baseline and 1 year.
- Circulating biomarkers (NT-proBNP), TIMI, and GRACE scores were evaluated at baseline.
Main Results:
- Patients in the highest LVMD quartile showed higher GRACE/TIMI scores, increased LV end-systolic volume, worse LVGLS, and elevated NT-proBNP.
- LVMD, LVGLS, and NT-proBNP levels were independent predictors of adverse cardiac remodeling.
- Incorporating LVMD into predictive models alongside NT-proBNP significantly improved risk discrimination.
Conclusions:
- Left ventricular mechanical dispersion measurement is valuable for risk stratification of adverse cardiac remodeling in STEMI patients post-PCI.
- LVMD may offer incremental prognostic information beyond established biomarkers and clinical scores.
Objective:
The aim of the study was to investigate whether increased left ventricular mechanical dispersion is an early predictor for adverse cardiac remodeling in ST-segment elevation myocardial infarction patients who had post-percutaneous coronary intervention thrombolysis in myocardial infarction (TIMI) flow grade > 2.
Methods:
A total of 119 post-percutaneous coronary intervention ST elevation myocardial infarction patients with TIMI flow grade >2 were prospectively included in the study. Left ventricular global longitudinal strain was quantified by 2-dimensional speckletracking echocardiography, and left ventricular mechanical dispersion was determined at baseline and after 1 year to assess adverse cardiac remodeling. The levels of circulating biomarkers were measured at the baseline. TIMI score and the Global Registry of Acute Coronary Events score systems were used to evaluate the prognosis of patients.
Results:
Patients with high quartile versus low quartile of left ventricular mechanical dispersion exerted higher Global Registry of Acute Coronary Events and TIMI score grades, left ventricular endsystolic volume, global longitudinal strain, and levels of the N-terminal fragment of brain natriuretic peptide and lower left ventricular ejection fraction. Multivariate log regression showed that N-terminal fragment of brain natriuretic peptide > 953 pg/mL, global longitudinal strain > -8%, and high quartile of left ventricular mechanical dispersion remained independent predictors for adverse cardiac remodeling. Addition of left ventricular mechanical dispersion to the N-terminal fragment of brain natriuretic peptide improved the discriminative potency of the whole model.
Conclusion:
Measurement of left ventricular mechanical dispersion might be useful in determining the risk of adverse cardiac remodeling in post-percutaneous coronary intervention ST elevation myocardial infarction patients.
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