Abstract 9346: Left Ventricular Dyssynchrony Estimated by Real time 3D Echocardiography Acutely Onset after ST-Elevation Myocardial Infarction Predicts Left Ventricular Remodeling

Abstract

Background: Left ventricular dyssynchrony, estimated by speckle-tracking radial strain immediately after AMI, has been recognized as a predictor of LV remodeling. Methods: The study included 119 consecutive patients (99men, 64years, maxCPK=3138±3642IU/l) presenting with a first ST-elevation AMI (STEMI) who underwent primary PCI within 12 hours of onset. Within 24 h of intervention, 2D echocardiography, including tissue Doppler, speckle-tracking strains, and 3D echocardiography, was performed by iE33 and Q-lab version 8.1 (CMQ and 3DQ ADV, Philips inc). Echocardiography was repeated 12 months later and LV remodeling was defined as an absolute increase in LVEDV of at least 20%. The absolute difference (Tmsv-16dif) and standard deviation (SD) of the time to regional LV minimum systolic volume (Tmsv-16SD) for all 16 segments were assessed by 3D echocardiography. The absolute differences in time-to-peak radial (Tm-rad), circumferential (Tm-cir), and longitudinal (Tm-lon) strains were assessed for the earliest versus the latest activated segments. Longitudinal images were obtained by their apical 4-, 2-, long axis view and longitudianal strain was calculated from these images. Results: In total, 37 patients had LV remodeling at the 12-month follow-up. Each dyssynchronous index was a significant predictor for LV remodeling. Table shows univariate and multivariate analysis for predicting LV remodeling. Multivariable analysis demonstrated that Tmsv-16SD was the independent predictor among these indexes (Odds ratio=1.183, CI : 1.039-1.441, p=0.0046). We corrected Tmsv-16SD by the R-R interval to give Tmsv-16SD%. The Tmsv-16SD% value strongly predicted LV remodeling (Odds ratio = 1.609, CI : 1.336-2.029, p<0.0001). Conclusions: In patients with a first STEMI, LV dyssynchrony assessed by 3D echocardiography immediately after reperfusion therapy can predict LV remodeling within 12 months.