Left Ventricular Remodeling In Patients Research Articles

Dinamika indeksa massy miokarda levogozheludochka u patsientov s arterial'noygipertoniey II-III stepeni na fone terapiiKo-renitekom i Gizaarom

The regress or left ventricular (LV) hypertrophy is a main end-point of antihypertensive therapy. The aim of the present study was to compare antihypertensive effects of two fixed combination preparations of ACE inhibitor and thiazide diuretic, enalapril 20 mg/hydrochlorthiazide 12,5 mg (Co-renitec) and losartan 50 mg/hydrochlorthiazide 12,5 mg (Hyzaar) on LV mass index (LVMI), types of left ventricular remodeling in patients with grade II-III arterial hypertension. First group was treated with Co-renitec, second group with Hyzaar during 24-weeks period. Results showed that both preparations significantly and to the same degree decrease LVMI. Number of patients with normal LV geometry increases with accompanying decrease in number of patients with concentric hypertrophy and concentric remodeling. The favorable effects were more remarkable in group treated with Hyzaar.

Effect of heart rate reduction by ivabradine on left ventricular remodeling in the echocardiographic substudy of BEAUTIFUL

Occlusive coronary artery disease (CAD) is associated with left ventricular (LV) remodeling, LV systolic dysfunction, and heart failure. The BEAUTIFUL Echo substudy aimed to evaluate the effects of heart rate reduction with ivabradine on LV size (primary end-point: change in LV end-systolic volume index [LVESVI]) and function and the cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP). The substudy was carried out in 86 centers participating in the BEAUTIFUL study. 2D echocardiography was performed at baseline, and after 3 and 12 months in patients with stable CAD and LV systolic dysfunction receiving ivabradine or placebo at the same time-points. All data were read and analyzed centrally. Of 525 patients completing the study, 426 had adequate echocardiographic readings (n = 220 ivabradine; n = 206 placebo). Treatment with ivabradine was associated with a decrease in the primary end-point LVESVI (change from baseline to last value, -1.48 ± 13.00 mL/m(2)) versus an increase with placebo (1.85 ± 10.54 mL/m(2)) (P=0.018). There was an increase in LV ejection fraction with ivabradine (2.00 ± 7.02%) versus no change with placebo (0.01 ± 6.20%) (P=0.009). Reduction in LVESVI was related to the degree of heart rate reduction with ivabradine. There were no differences in any other echocardiographic parameters or NT-proBNP. Change in LVESVI was related to the log change in NT-proBNP in the ivabradine group only (r = 0.18, P = 0.006). Our observations suggest that ivabradine may reverse detrimental LV remodeling in patients with CAD and LV systolic dysfunction.

Design and rationale of the Reduction of Infarct Expansion and Ventricular Remodeling with Erythropoietin after Large Myocardial Infarction (REVEAL) trial

Acute myocardial infarction (MI) remains a leading cause of death despite advances in pharmacologic and percutaneous therapies. Animal models of ischemia/reperfusion have demonstrated that single-dose erythropoietin may reduce infarct size, decrease apoptosis, and increase neovascularization, possibly through mobilization of endothelial progenitor cells. REVEAL is a randomized, double-blind, placebo-controlled, multicenter trial evaluating the effects of epoetin α on infarct size and left ventricular remodeling in patients with large MIs. The trial comprises a dose-escalation safety phase and a single-dose efficacy phase using the highest acceptable epoetin α dose up to 60,000 IU. Up to 250 ST-segment elevation myocardial infarction patients undergoing primary or rescue percutaneous coronary intervention will be randomized to intravenous epoetin α or placebo within 4 hours of successful reperfusion. The primary study end point is infarct size expressed as a percentage of left ventricular mass, as measured by cardiac magnetic resonance imaging 2 to 6 days post study medication administration. Secondary end points will assess changes in endothelial progenitor cell numbers and changes in indices of ventricular remodeling. The REVEAL trial will evaluate the safety and efficacy of the highest tolerated single dose of epoetin α in patients who have undergone successful rescue or primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

E0438 Bone marrow cell therapy improves systolic function whereas has no effect on remodelling of left ventricular in patients with acute myocardial infarction: a meta-analysis of randomised controlled trials

ObjectivesThe objective is to perform a meta-analysis of clinical trials that investigated the effects of bone marrow cell (BMC) therapy on left ventricular (LV) function and LV remodelling in patients...

E0649 Long-term effects of RA-URIS pacing on left ventricular remodelling in patients with chronic heart dysfunction

ObjectiveTo assess the effects of RA-URIS dual chamber sequential pacing on left ventricular remodelling and cardiac function in SSS or AVB patients with chronic heart dysfunction.Methods32 patients with SSS or...

Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging

To describe the time course of myocardial infarct (MI) healing and left ventricular (LV) remodelling and to assess factors predicting LV remodelling using cardiac MRI. In 58 successfully reperfused MI patients, MRI was performed at baseline, 4 months (4M), and 1 year (1Y) post MI RESULTS: Infarct size decreased between baseline and 4M (p < 0.001), but not at 1Y; i.e. 18 ± 11%, 12 ± 8%, 11 ± 6% of LV mass respectively; this was associated with LV mass reduction. Infarct and adjacent wall thinning was found at 4M, whereas significant remote wall thinning was measured at 1Y. LV end-diastolic and end-systolic volumes significantly increased at 1Y, p < 0.05 at 1Y vs. baseline and vs. 4M; this was associated with increased LV sphericity index. No regional or global LV functional improvement was found at follow-up. Baseline infarct size was the strongest predictor of adverse LV remodelling. Infarct healing, with shrinkage of infarcted myocardium and wall thinning, occurs early post-MI as reflected by loss in LV mass and adjacent myocardial remodelling. Longer follow-up demonstrates ongoing remote myocardial and ventricular remodelling. Infarct size at baseline predicts long-term LV remodelling and represents an important parameter for tailoring future post-MI pharmacological therapies designed to prevent heart failure.

Section 5: Management of Asymptomatic Patients with Reduced Left Ventricular Ejection Fraction

Section 5: Management of Asymptomatic Patients with Reduced Left Ventricular Ejection Fraction

Effects of Stem Cell Therapy on Left Ventricular Remodeling After Acute Myocardial Infarction: A Meta‐Analysis

The objective was to perform a meta-analysis of clinical trials that investigated the effects of stem cell therapy on left ventricular remodeling in patients after acute myocardial infarction (AMI). Intracoronary injection of stem cells in the acute phase of myocardial infarction has been proposed to replace the cardiomyocytes lost and to prevent deleterious pathological remodeling after myocardial infarction. Previously published trials have investigated the effects of cell therapy on left ventricular (LV) remodeling in AMI patients. However, the sample size of these studies is small and the conclusions are inconsistent. Trials were identified in the Cochrane Library, EMBASE, and PubMed databases, reviews, and reference lists of relevant articles. The weighted mean difference (WMD) was calculated for net changes in LV end-diastolic and end-systolic volumes (LVEDV and LVESV) by using fixed-effect models. A total of 11 trials (13 comparisons) with 832 participants evaluated the association between stem cell therapy and changes in LVEDV. Compared with the control group, stem cell therapy did not influence the LVEDV changes from baseline to follow-up (WMD: - 1.76 mL, 95% confidence interval [CI]: - 4.61 to 1.08 mL, P = 0.233). A total of 9 trials (11 comparisons) with 797 participants evaluated the association between stem cell therapy and changes in LVESV. Compared with the control group, patients in the cell therapy group had a significantly greater reduction in LVESV from baseline to follow-up (WMD: - 5.08 mL, 95% CI: - 7.80 to - 2.37 mL, P < 0.001). This meta-analysis suggests that cell therapy improves left ventricular contractility, but has no effect on LV remodeling.

Neopterin predicts left ventricular remodeling in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in patients with ST-segment elevation myocardial infarction (STEMI). Methods We prospectively assessed 108 STEMI patients (age 64 ± 11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96 ± 10 h after the onset of symptoms and 12 month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12 months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI. Results At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45 ± 1.04 vs 5.19 ± 1.39 nmol/L; p < 0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928–4.990, p < 0.001] to [3.32, CI 95% 1.999–5.532, p < 0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84–0.96, p < 0.0001) compared to 0.579 for BNP (CI 95% 0.409–0.748) regarding LVR. Conclusions In STEMI patients undergoing primary PCI, high neopterin levels – but not BNP – predict LVR at 1-year follow-up.

The use of H1-receptor antagonists and left ventricular remodeling in patients on chronic hemodialysis

Suppression of left ventricular (LV) remodeling secondary to heart failure seems critical to improve the prognosis of hemodialysis (HD) patients. This is a retrospective study on the relationship of an antiallergic drug and antihistamines with LV hypertrophy. A total of 149 patients (88 males and 61 females) were entered in the study. Mean age was 66.7 years and mean duration of dialysis 14.4 years. Twenty-three patients received oral treatment with an antiallergic drug or second-generation antihistamines, 3 with the antiallergic drug and 20 with antihistamines. The multivariate analysis using LV mass index (LVMI) as the objective variable extracted the following independent factors: male sex, erythropoietin (EPO)/w, uric acid (UA), total cholesterol, antihistamines, antiallergic drug, and calcium channel blocker (CCB), with a standard regression coefficient of 0.187, 0.196, 0.212, -0.262, -0.215, -0.149 and -0.173, respectively. This study suggests a suppressive role of second-generation antihistamines on LV remodeling. Male sex, high-dose EPO/w, and elevated UA were considered as aggravating factors, and CCB as a suppressive factor.

Adiponectin Resistance in Heart Failure and the Emerging Pattern of Metabolic Failure in Chronic Heart Failure

In recent years, an interesting shift in our understanding of chronic heart failure (CHF) pathophysiology may be observed. Beyond the traditional concepts of hemodynamic failure and neuroendocrine activation, it is increasingly appreciated that CHF is a much more complex and truly systemic disease including the peripheral organs and whole body regulatory processes as well. Novel concepts such as the systemic inflammatory immune activation and the skeletal muscle hypothesis have emerged.1 These concepts recognize the significant contribution of peripheral changes to symptomatic status, disease progression, and outcome in CHF. Article see p 185 A further novel facet in heart failure pathophysiology has emerged recently because impaired regulation of systemic metabolic balance is increasingly in the focus of clinical research. The emerging picture suggests a complex but characteristic pattern of metabolic pathways that are imbalanced, attenuated, or abnormally activated. Hormonal imbalances have been previously observed as common features in CHF, such as insulin resistance2 and growth hormone resistance3 that contribute to both morbidity and mortality of patients. The metabolic interaction of neuroendocrine activation and immune activation such as from cytokines and oxygen radical accumulation add to the complexity of these interrelated processes. In general, the findings repeat, again, the classical concept of short-term beneficial adaptive responses on acute injury or disease may eventually turn into harmful maladaptive signals on prolonged and chronic activation. The overall clinical effects that may be observed from impaired energy metabolic efficacy contribute to impaired exercise capacity, muscle fatigue, and early exhaustion—key symptoms in heart …

Angiotensin converting enzyme 2 gene expression increased compensatory for left ventricular remodeling in patients with end-stage heart failure

It has been reported that angiotensin converting enzyme (ACE) 2, a homologue of ACE, has direct effects on cardiac function. However, the role of ACE2 in the development of human heart failure is not fully understood. We evaluated the expression of the ACE2 gene by means of real-time RT-PCR in myocardium from 14 patients with end-stage heart failure. The amount of ACE2 mRNA positively correlated with left ventricular (LV) end-diastolic diameter (r(2)=0.56, p<0.01) but did not significantly correlate with LV ejection fraction or plasma brain natriuretic peptide levels. In conclusion, our data show that the up-regulation of the ACE2 gene in the LV myocardium of patients with severe heart failure was associated with the degree of LV dilatation and may thereby constitute an important adaptive mechanism to retard the progression of adverse LV remodeling.

070 Cardiac resynchronization therapy and left ventricular remodeling in patients with coronary artery disease and dilated cardiomyopathy

We evaluated left ventricular remodeling (LVR) in patients (pts) with heart failure (HF) of the 2 main aetiologies, coronary artery disease (CAD) and dilated cardiomyopathy (DCM) after 1 year (y) of cardiac resynchronization therapy (CRT). We enrolled 65 HF outpts with CRT indication (mean age 67.5±13.2 ys 74.6% males, M): 33 had CAD-caused HF (70.2±6.7 ys, 84.4% M) and 32 DCM (64.6±17.3 ys, 64.5% M). All underwent ECG, echocardiography, NYHA evaluation before and after 1 y of CRT. Before CRT, NYHA was similar (CAD 2.7±0.7, DCM 2.7±0.8) and after 1 y it significantly (p<0.05) and equally improved in both (CAD 2.3±0.5, DCM 2.2±0.7). Before CRT left ventricular ejection function (EF,%) was significantly (p=0.04) less in DCM (22.9±7.7) than CAD (26.3±7.3) while end-diastolic (EDV, ml) and end-systolic (ESV) volume, end-diastolic (EDD, mm) and end-systolic (ESD) diameter were significantly greater in DCM than CAD (EDV 239±78 vs 207±62 p=0.04, ESV 192±81 vs 152±57 p=0.03, EDD 72.8±8.1 vs 68.8±8.6 p=0.05, ESD 59.5±10.7 vs 53.8±8.8 p=0.03). After 1 y EF significantly improved in both (DCM 28.8±9.5 p=0.01, CAD 29.5±7.4 p=0.05) with a borderline trend to a greater increase in DCM. After 1 y EDV, ESV, EDD and ESD were reduced in both, with a significant reduction only in DCM. Expressing LVR as the volume parameters variation (Δ), it was significantly greater in DCM than CAD: ΔEDV DCM 44±72 vs CAD 20±34, p=0.04; ΔESV DCM 47±64 vs CAD 19±35, p=0.04. Before CRT QRS duration (msec) was similar in both (DCM 172±33 CAD 176±28, p=ns) as well as after (DCM 123±33 CAD 134±31, p=ns). Pre and post-CRT QRS duration and ΔQRS weren’t related to any modification of the above indicated parameters, both in the overall population and the 2 groups. Thus, CRT determines EF increase and LVR regression in both examined HF aetiologies. Volume reduction is greater in DCM than CAD. No relation exists between the volume and function parameters modifications and QRS duration both before and after CRT.

Pro/Anti-Inflammatory Cytokine Imbalance in Postischemic Left Ventricular Remodeling

Objectives. Cytokines play an important role in left ventricular remodeling consequent to myocardial ischemia. The aim of this study was to correlate cytokine production and lymphocyte apoptosis to post-ischemic left ventricular remodeling in patients affected by acute myocardial infarction (AMI) undergoing primary cutaneous angioplasty (PCI). Methods. In 40 patients, affected by AMI and undergoing PCI, we evaluated peripheral blood mononuclear cells (PBMCs), tumor necrosis factor-alpha (TNF-α) and interleukin 10 (IL10) production and apoptosis on day 1, day 3, day 7, 1 month and 6 months after PCI. Patients were divided into two subgroups of remodeling or not remodeling by echocardiographic criteria. Results. In the subgroup of remodeling patients, at each timepoint TNF-α production was increased significantly in comparison with the subgroup of not remodeling patients. IL10 production was statistically lower in remodeling subjects than in not remodeling ones 1 and 6 months after reperfusion. There were no differences between the two groups as regards lymphomonocyte apoptosis. Conclusions. We found an increased production of pro-inflammatory cytokine TNF-α and a corresponding decrease of anti-inflammatory/regulatory cytokine IL10 in remodeling patients and we concluded that this cytokine imbalance resulted in pro-inflammatory effects which might contribute to the progression of left ventricular remodeling.

Beneficial effects of biventricular pacing in chronically right ventricular paced patients with mild cardiomyopathy

To investigate whether cardiac resynchronization therapy (CRT) by means of biventricular (BiV) pacing can improve left ventricular (LV) function, remodelling and clinical status in chronically right ventricular (RV) paced patients with mild cardiomyopathy. Thirty-six chronically (10 +/- 7 years) RV paced patients with left ventricular ejection fraction (LVEF) < 40% or LVEDD > 55 mm, without an established indication for CRT, were subjected to 6 months RV and BiV pacing in a patient-blinded, randomized crossover design. Treatment-effects of BiV pacing were evaluated for LV function, LV remodelling and clinical status. As compared with RV pacing, BiV pacing significantly improved LV function (LVEF 46 +/- 12 vs. 39 +/- 12% and LVFS 24 +/- 7 vs. 21 +/- 7%) and reduced LV end-diastolic and end-systolic diameters and volumes (LVEDD 56 +/- 8 vs. 59 +/- 8 mm, LVESD 43 +/- 8 vs. 47 +/- 9 mm, LVEDV 132 +/- 65 vs.144 +/- 62 mL and LVESV 77 +/- 56 vs. 92 +/- 55 mL, respectively). In 19 patients (53%) response to BiV pacing was clinically relevant, defined as LVESV reduction >15%. BiV pacing also significantly improved NYHA classification. BiV pacing following chronic RV pacing may improve LV function and reverse LV remodelling in patients with relatively mild LV dysfunction or remodelling. Hence, upgrade to BiV pacing might be considered in chronically RV paced patients with mild cardiomyopathy.

Left ventricular remodeling in patients in patients with thyrotoxicosis

The aim of this paper was to investigate cardiac remodelling in thyrotoxicosis. The geometric parameters of the left ventricle (LV) and the readings of tissue Doppler echocardiography were compared in 27 patients (mean age 53.3±9.2 years) who had first-diagnosed moderate thyrotoxicosis without concomitant cardiac pathology and in 16 healthy individuals (mean age 45.1±4.7 years). The baseline data and the results of incremental treadmill exercise tests were analyzed. It was shown that in the relatively early periods of thyrotoxicosis development, there were decreases in the left ventricle (LV) longitudinally and transversely and in the thickness of LV, without altering its sphericity and conicity. Along with weight loss, there were reductions in cardiac sizes with decreases in the local rates of cardiac wall movement, peak systolic and early diastolic rates of mitral movement velocities. During a treadmill test, there was a drastic reduction in the exercise tolerance threshold as compared to healthy individuals: 57.81±14.7 and 148.3±11.7 W, respectively.

Value of convex-type ST-segment elevation and abnormal Q waves for electrocardiographic-based identification of left ventricular remodeling in hypertrophic cardiomyopathy.

Several studies have demonstrated that the natural course of hypertrophic cardiomyopathy can be variable, often unpredictable with high morbidity and mortality. Therefore, screening for potential cases and periodical evaluation of affected patients is compelling. The purpose of our study is to assess a relationship of the electrocardiographic finding of ST-segment elevation and/or abnormal Q waves with the development of left ventricular enlargement and wall motion abnormalities in the echocardiography and to propose these findings as a sign of left ventricular remodeling in patients with hypertrophic cardiomyopathy. We enrolled 110 patients with hypertrophic cardiomyopathy. Standard echocardiography and 12-lead electrocardiograms were analyzed. After initial evaluation, follow up was conducted with a mean interval of 20.3 months. In the electrocardiograms we found ST-segment elevation in 43.6% and abnormal Q waves in 18.1%; and left ventricular enlargement in 12.7% and wall motion abnormalities in 21.8% in the echocardiograms. Three different patterns of ST-segment elevation were acknowledged: concave (13.6 %), straight (16.3 %) and convex (13.6%). There was a close relationship between the electrocardiographic finding of convex ST-segment elevation and/or abnormal Q waves and the occurrence of left ventricular enlargement and/or wall motion abnormalities in the echocardiograms with a sensitivity of 62% and a specificity of 85%. However, the straight and concave-type ST-segment elevation showed a less significant relationship with the echocardiographic findings. This study suggested that the electrocardiographic finding of convex ST-segment elevation and abnormal Q waves could be valuable for detection of disease progression in patients with hypertrophic cardiomyopathy.

POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: A randomized trial

Surgical management of moderate chronic ischemic mitral valve regurgitation is still debated. The aim of this study was to evaluate the effect of adding mitral valve repair to coronary artery bypass grafting on clinical outcomes and left ventricular remodeling in patients who underwent coronary artery bypass grafting alone versus coronary artery bypass grafting plus mitral valve repair in a randomized trial. Between February 2003 and May 2007, 102 patients were eligible for this study and were randomly assigned to one of 2 groups by means of card allocation: coronary artery bypass grafting plus mitral valve repair (CABG plus MVR group; 48 patients, 47%) or coronary artery bypass grafting alone (CABG group; 54 patients, 53%). The 2 groups were similar regarding demographics, perioperative clinical data, and outcomes. There were differences regarding cardiopulmonary bypass (P < .0001) and aortic crossclamp (P < .0001) times. Exercise tests were performed for all survivors to evaluate tolerance to exercise and variability on grade of mitral regurgitation and systolic pulmonary arterial pressure. The study was blinded for physicians and nurses involved in postoperative care and clinical follow-up. The mean follow-up was 32 +/- 18 months. Overall in-hospital mortality was 3% (3 patients). One (1.8%) patient died in the CABG group, and 2 (4.1%) patients died in the CABG plus MVR group. Survival rates +/- standard error at 5 years for patients in the CABG and CABG plus MVR groups were 88.8% +/- 3.2% and 93.7% +/- 3.1%, respectively. A significant difference was found between the 2 groups with regard to mean New York Heart Association class (P < .0001), left ventricular end-diastolic diameter (P < .01), left ventricular end-systolic diameter (P < .01), pulmonary arterial pressure (P < .0001), and left atrial size (P < .01). At follow-up, coronary artery bypass grafting alone was able to reduce mitral regurgitation grade in 40% of patients, whereas in the remaining patients mitral regurgitation grade remained stable or worsened. In the CABG group, among the 17 patients with mild mitral regurgitation and 12 patients with moderate mitral regurgitation at rest, 7 (40%) and 9 (75%) patients, respectively, had worsening in mitral regurgitation grade and pulmonary artery pressure during exercise. The efficacy of adding mitral valve repair to coronary artery bypass grafting is well demonstrated by the improvement of New York Heart Association functional class and percentage of left ventricular ejection fraction and by the decrease of mitral regurgitation grade, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, pulmonary artery pressure, and left atrial size. Moreover, coronary artery bypass grafting alone left more patients with heart failure symptoms at rest and during exercise. Combined coronary artery bypass grafting and mitral valve repair have no effect on survival at short-term follow-up, and the trends that are evident will likely become more significant with time.

Usefulness of Left Ventricular Dyssynchrony After Acute Myocardial Infarction, Assessed by a Tagging Magnetic Resonance Image Derived Metric, as a Determinant of Ventricular Remodeling

Development of left ventricular (LV) remodeling after acute myocardial infarction (AMI) is a serious medical complication. We investigated the correlation of LV dyssynchrony after AMI with LV remodeling using magnetic resonance-myocardial tagging (MR-MT) derived dyssynchrony index (circumferential uniformity ratio estimate [CURE]). Forty-three patients diagnosed with ST-elevation AMI were analyzed. After treatment with primary percutaneous intervention, cardiac magnetic resonance imaging was performed to obtain a cine image, a delayed enhancement image, and an MR-MT image. CURE as a dyssynchrony index was calculated from the MR-MT image using HARP software (CURE 0 to 1 = dyssynchrony to synchrony). After 6 months, follow-up cardiac magnetic resonance imaging was performed to assess degree of LV remodeling. Sixteen patients (37%) had an increased LV end-systolic volume (ESV) >15% compared with baseline. The baseline LV dyssynchrony index, CURE, was significantly associated with ESV at 6 months (r = -0.49, p <0.001) and weakly correlated with change in ESV (percentage) compared with baseline values (r = -0.26, p = 0.08). Multivariate analysis showed that CURE was associated only with change in ESV (beta -0.39, p = 0.03). Subgroup analysis for patients with nonviable myocardium (infarct thickness >75%, n = 31) showed that this correlation was stronger (beta -0.52, p = 0.006), suggesting that CURE could predict progression of LV remodeling in patients with AMI and nonviable myocardium. LV dyssynchrony immediately after AMI is an important determinant of LV remodeling. In conclusion, the MR-MT dyssynchrony index, CURE, might be useful for prediction of LV remodeling in patients with AMI.

Real-Time 3-Dimensional Echocardiography

One of the most significant developments of the last decade in ultrasound imaging of the heart was the evolution of 3-dimensional (3D) imaging from slow and labor-intense offline reconstruction to real-time volumetric imaging. This imaging modality provides valuable clinical information that empowers echocardiographers with new levels of confidence in the diagnosis of heart disease. We have previously described the technological milestones in the development of real-time 3D echocardiographic (RT3DE) imaging and its major advantages over conventional 2-dimensional echocardiography (2DE) and reviewed the published literature that supported the use of this new methodology in clinical practice.1 Since 2006, the growing availability of RT3DE technology, its ease of use, and its multiple attractive features have sparked significant interest in the research community, resulting in a large number of publications, most of which have endorsed RT3DE imaging for clinical use by demonstrating its unique capabilities in different scenarios. In parallel, the clinical acceptance of this new tool has broadened significantly. The most recent clinically significant addition is matrix-array transesophageal echocardiography (TEE), which provides images of unprecedented quality that aid surgeons and interventional cardiologists in planning and guiding procedures and evaluating their outcomes. The purpose of the present article is to review the most recent RT3DE literature and provide readers with an update on the latest developments and the current status of this noninvasive imaging tool. Because different potential applications of RT3DE imaging have been explored to various extents, they are described here separately, and each is discussed with an emphasis on the scientifically established facts, along with the known stumbling blocks and difficulties. A firmly established advantage of 3D imaging over cross-sectional slices of the heart is the improvement in the accuracy of the evaluation of left ventricular (LV) volumes and ejection fraction (EF) by eliminating the need for geometric modeling, which …