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Early identification of patients at risk for significant left ventricular dilation one year after myocardial
P E Assmann1, W R Aengevaeren, J G Tijssen
1Department of Cardiology, Erasmus University, Rotterdam, The Netherlands.
Insights
Early identification of patients at risk for left ventricular (LV) dilation after myocardial infarction is possible. Combining initial echocardiography (end-diastolic volume index) and infarct size predicts significant LV dilation one year later.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- Acute myocardial infarction (AMI) can lead to significant left ventricular (LV) remodeling and dilation.
- Identifying patients at risk for LV dilation early is crucial for timely intervention.
- Predictive criteria for LV dilation post-AMI require further investigation.
Purpose of the Study:
- To prospectively identify early criteria for predicting significant LV dilation one year after AMI.
- To evaluate the predictive value of initial echocardiographic and clinical parameters for LV dilation.
Main Methods:
- Prospective study of 54 patients treated with thrombolysis within 4 hours of AMI symptom onset.
- Two-dimensional echocardiography assessed end-diastolic volume index (EDVI) and end-systolic volume index initially and at 1-year follow-up.
- Enzymatic infarct size and other clinical/angiographic data were also analyzed.
Main Results:
- Significant LV dilation occurred in 26% of patients by 1 year post-AMI.
- Initial EDVI and enzymatic infarct size were the optimal multivariate predictors of significant LV dilation (sensitivity 86%, specificity 79%).
- Early prediction of LV dilation was achieved within 3 days of AMI.
Conclusions:
- A simple method combining initial EDVI and enzymatic infarct size can effectively identify patients at risk for significant LV dilation.
- This approach facilitates early selection of patients requiring intervention after acute myocardial infarction.
- Further research should explore the clinical utility of these predictive criteria in broader patient populations.
Abstract:
We prospectively investigated criteria to identify patients in the early phase of acute myocardial infarction at risk for significant left ventricular (LV) dilation 1 year after myocardial infarction. In 54 patients receiving thrombolysis within 4 hours after onset of symptoms, the end-diastolic volume index (EDVI) and the end-systolic volume index were assessed by two-dimensional echocardiography initially (within 23 +/- 21 hours) and 1 year after myocardial infarction. After 1 year, LV dilation occurred in 51 patients (94%) and was significant (> mean normal value + 2 SDs) in 14 patients (26%). Significant univariate predictors (p < 0.05) for LV dilation were age, anterior myocardial infarction, initial EDVI and end-systolic volume index, enzymatic infarct size, LV end-diastolic pressure, and mitral regurgitation. No other variables obtained from clinical information, two-dimensional echocardiography, or angiography, including residual coronary perfusion or stenosis, had predictive value. The optimal multivariate predictive model was the combination of the initial EDVI and the enzymatic infarct size, which correctly predicted significant LV dilation in 12 of 14 patients and falsely in eight of 39 patients (sensitivity 86%; specificity 79%). Patients at risk for significant LV dilation 1 year after myocardial infarction were identified adequately 3 days after myocardial infarction by the combination of the initial echocardiographic assessment of EDVI and the enzymatic infarct size. Thus a simple method could facilitate the selection of patients for intervention after acute myocardial infarction.