Absence Of Left Ventricular Remodeling Research Articles

Two-Dimensional Speckle Tracking Echocardiography Predict Left Ventricular Remodeling after Acute Myocardial Infarction in Patients with Preserved Ejection Fraction.

ObjectivesLeft ventricular remodeling after acute myocardial infarction increases cardiovascular events and mortality. But few study was done in patients with preserved ejection fraction (EF > 40%). We investigate whether the strain and strain rate by 2D speckle tracking echocardiography could predict left ventricular remodeling after acute myocardial infarction in this cohort.MethodsThe 83 patients (average age 60.7 ± 12.3 y, 75 [90.4%] male) with new-onset acute myocardial infarction receiving echocardiography immediately, and 6 months after admission were grouped by the presence or absence of left ventricular remodeling. Strain and strain rate including longitudinal, circumferential, and radial direction were calculated. The average of strain and strain rate of which segmental longitudinal strains > – 15% were defined as the injury longitudinal strain (InjLS).ResultsLeft ventricular remodeling occurred in 24 of 83 patients (28.9%). In univariate logistic regression analyses, gender, peak CK-MB, log BNP, use of statin before discharge, wall motion score index, and InjLS were significantly associated with left ventricular remodeling (p < 0.05). In multivariate analysis using the forward stepwise method, gender, CK-MB, and InjLS were independent predictors. The hazard ratio for InjLS was 1.48 (p = 0.04). Receiver operating characteristic curve (ROC) analyses showed the area under the curve (AUC) of InjLS was largest (AUC = 0.75, cut-off value = –11.7%, sensitivity = 81%, specificity = 71%, p < 0.01). In ST-segment elevation myocardial infarction subgroup, InjLS was the only predictor according to ROC analysis (AUC = 0.79, p < 0.01, cut-off value = –11.4%, sensitivity = 88%, specificity = 77%) and multivariate logistic regression analysis (hazard ratio = 1.88, 95% CI: 1.22–2.88, p < 0.01).ConclusionsInjLS was an excellent predictor for left ventricular remodeling after acute myocardial infarction in patient with preserved ejection fraction.

Elevation of matrix metalloproteinase-2 level in pericardial fluid is closely associated with left ventricular remodeling

The left ventricular (LV) extracellular matrix participates in progressive LV remodeling that is strongly associated with morbidity and mortality in patients with heart failure. Matrix metalloproteinases (MMPs), an endogenous family of zinc-dependent enzymes, increase proteolytic activity in the extracellar spaces, leading to increased extracellular remodeling. 1 Woessner J.F Matrix metalloproteinases and their inhibitors in connective tissue remodeling. FASEB J. 1991; 5: 2145-2154 Crossref PubMed Scopus (3071) Google Scholar , 2 Dollery C.M McEwan J.R Henney A.M Matrix metalloproteinases and cardiovascular disease. Circ Res. 1995; 77: 863-868 Crossref PubMed Scopus (812) Google Scholar Several lines of evidence in experiment animals suggest that MMPs and tissue inhibitors of metalloproteinases (TIMPs) may play an important role in modulating LV remodeling. 3 Thomas C.V Coker M.L Zellner J.L Handy J.R Crumbley A.J Spinale F.G Increased matrix metalloproteinase activity and selective upregulation in LV myocardium from patients with end-stage dilated cardiomyopathy. Circulation. 1998; 97: 1708-1715 Crossref PubMed Scopus (416) Google Scholar , 4 Spinale F.G Coker M.L Krombach S.R Mukherjee R Hallak H Houck W.V Clair M.J Kribbs S.B Johnson L.L Peterson J.T Zile M.R Matrix metalloproteinase inhibition during the development of congestive heart failure effects on left ventricular dimensions and function. Circ Res. 1999; 85: 364-376 Crossref PubMed Scopus (296) Google Scholar In humans, however, little information is available regarding MMPs and TIMPs of cardiac origin in the presence or absence of LV remodeling in patients with ischemic heart disease. It is generally considered that pericardial fluid is not only an ultrafiltrate of plasma, but also a transudate from the cardiac interstitium. 5 Fujita M Komeda M Hasegawa K Kihara Y Nohara R Sasayama S Pericardial fluid as a new material for clinical heart research. Int J Cardiol. 2001; 77: 113-118 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Thus, the purposes of this study were: (1) to measure plasma and pericardial fluid levels of total MMP-1 and -2, active MMP-2, and TIMP-1 and -2 in patients with ischemic heart disease, and (2) to investigate their relations to LV volume and function to obtain clinical evidence that MMPs act as autocrine and/or paracrine factors in the process of LV remodeling.