Predictor Of Left Ventricular Functional Recovery Research Articles

Predictive Value of Cardiac Magnetic Resonance Imaging-Derived Myocardial Strain for Poor Outcomes in Patients with Acute Myocarditis.

ObjectiveTo evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis.Materials and MethodsWe retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome.ResultsDuring an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042).ConclusionCMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.

Left Atrial Volume as a Predictor of Left Ventricular Functional Recovery in Patients With Dilated Cardiomyopathy and Absence of Delayed Enhancement in Cardiac Magnetic Resonance

BackgroundImprovement of left ventricular (LV) systolic dysfunction can occur in patients with dilated cardiomyopathy (DCM), and it is more frequently observed if patients have no delayed enhancement (DE) in cardiac magnetic resonance imaging (CMR). However, even in the absence of DE, not all patients have functional recovery. We retrospectively investigated the predictors of LV functional recovery in patients with DCM who had no DE in CMR. MethodsA total of 136 patients with DCM underwent CMR. Among them, 44 (29 male, age 55 ± 14 years) showed no DE and these patients composed the study population. The study patients were divided into 2 groups according to the occurrence of functional recovery defined as an increase in LV ejection fraction to a level of ≥50% and net increase in ejection fraction of 20% or more: group 1 (n = 14) with functional recovery and group 2 (n = 30) without functional recovery. ResultsIn patients who showed functional recovery, left atrial volume index (LAVI [26 ± 8 mL/m2 vs 45 ± 18 mL/m2]) and LV end-diastolic dimension (62 ± 6 mm vs 67 ± 7 mm) were significantly smaller when compared with those without functional recovery (P < .05 for all). In Cox multiple regression analysis, LAVI was the only significant parameter associated with LV functional recovery (hazard ratio 0.932, 95% confidence interval 0.877–0.991, P = .024). LAVI < 38 mL/m2 had 100% specificity in predicting the improvement of LV systolic dysfunction. ConclusionIn DCM patients who had no DE in CMR, LAVI predicts LV functional recovery with high specificity.

Role of intraoperative electrical parameters in predicting reverse remodelling after cardiac resynchronization therapy and correlation with interventricular mechanical dyssynchrony

Cardiac resynchronization therapy (CRT) was shown to reverse left ventricular (LV) remodelling in heart failure (HF) patients. We aimed to investigate whether intraoperative electrical parameters (IEP) were predictive factors of LV reverse remodelling and were correlated with mechanical dyssynchrony indexes. Eighty-six patients with HF underwent CRT. At implant, several electrical and echocardiographic parameters were evaluated and, at 6 months, responders were defined by a relative increase in LV ejection fraction ≥25% compared with baseline. Several IEPs were shown to predict LV reverse remodelling. Receiver operating curve analysis revealed the ratio between QRS duration during biventricular pacing (BVp) and right ventricular pacing (RVp) [QRS(BVp)/QRS(RVp)] as the best predictor of LV functional recovery after CRT (AUC = 0.72; 95% confidence limit 0.57-0.82; P < 0.001). Responders showed a lower value of QRS(BVp)/QRS(RVp) when compared with non-responders (0.74 ± 0.05 vs. 0.8 ± 0.1; P < 0.005) and 0.78 was the value associated with the best predictive accuracy. The interval between the onset of RV lead and LV lead electrograms (RVegm-LVegm) during baseline rhythm correlated directly with the interventricular mechanical delay (IVMD) (r = 0.68; P < 0.0001) and with its reduction (delta IVMD) at follow-up (r = 0.66; P < 0.0005). Intraoperative electrical parameters can predict LV functional recovery after CRT and they are correlated with interventricular mechanical resynchronization at follow-up.

Left Ventricular Function After ST-Elevation Myocardial Infarction in Patients Treated With Primary Percutaneous Coronary Intervention and Abciximab or Tirofiban (from the Facilitated Angioplasty with Tirofiban or Abciximab [FATA] Trial)

Abciximab therapy during primary percutaneous coronary intervention (PCI) has shown to ameliorate left ventricular (LV) function recovery in patients with ST elevated myocardial infarction. High-dose bolus tirofiban has similar effect on platelet inhibition. Whether this is associated with comparable efficacy on LV function recovery remains unclear. We sought to evaluate the impact on LV function of high-dose bolus tirofiban or abciximab in patients undergoing primary PCI with the predictors of favorable (> or = 50%) LV ejection fraction (EF) and LV function recovery at 30 days. We studied 314 patients (abciximab n = 154; tirofiban n = 160) undergoing primary PCI in the randomized Facilitated Angioplasty with Tirofiban or Abciximab (FATA) Trial. LVEF was assessed within 48 hours and at 30 days after primary PCI. In patients with systolic dysfunction at baseline, LV function recovery was defined by either increase of LVEF > or = 10% compared with baseline or LVEF > or = 50%. Similar LVEF was observed in the 2 groups postprocedure (abciximab 49.7 +/- 10.1% vs tirofiban 49.3 +/- 10.1%, p = 0.9) and at 30 days (abciximab 53.1 +/- 9.8% vs tirofiban 52.5 +/- 10.2%, p = 0.6). Independent predictors of 30-day LVEF > or = 50% were preprocedure Thrombolysis In Myocardial Infarction flow class >0 (odds ratio = 2.4, 95% confidence interval 1.32 to 4.34), anterior location (odds ratio = 0.25, 95% confidence interval 0.15 to 0.42), and age (odds ratio = 0.97, 95% confidence interval 0.95 to 0.99). Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 was the only predictor of LV function recovery (odds ratio = 6.73, 95% confidence interval 2.69 to 16.88). In conclusion, this study showed no difference in LV function recovery in patients undergoing primary PCI treated either with abciximab or high-dose bolus tirofiban. Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 seems to be the most important predictor of favorable LVEF and LV function recovery at 30 days.

Prevalence, Predictors, Time Course, and Long-Term Clinical Implications of Left Ventricular Functional Recovery After Mechanical Reperfusion for Acute Myocardial Infarction

This study prospectively evaluated the prevalence, predictors, time course, and prognostic impact of left ventricular (LV) functional recovery after successful primary percutaneous coronary intervention in 228 consecutive patients with acute myocardial infarctions (AMIs) and LV dysfunction. Serial echocardiographic exams were performed within 24 hours (time 1) and at 1 month (time 2) and 6 months (time 3) after AMI. Overall, 133 patients (58%) showed significant LV functional recovery (> or =10% ejection fraction increase compared with time 1 or ejection fraction > or =50%) at time 3. Early (from time 1 to time 2) and late (from time 2 to time 3) functional recovery patterns were detected in 102 patients (45%) and 31 patients (14%), respectively. Independent predictors of LV functional recovery were enzymatic infarct size (p = 0.0001), time from symptom onset to reperfusion (p = 0.022), extent and severity of baseline LV wall motion abnormalities (p = 0.007), and female gender (p = 0.031). Six-month LV remodeling rates were 36% and 64% in patients with and without LV functional recovery (p = 0.0001). The five-year cardiac death rate was significantly lower in patients with LV functional recovery than in those without (8% vs 18%, respectively, p = 0.024). The time course of LV functional recovery during 6 months did not significantly affect long-term survival. In conclusion, after successful mechanical reperfusion of AMIs, nearly half of patients showed poor LV functional recovery. The presence of significant LV functional recovery 6 months after reperfused AMI, but not the specific time course of recovery, is clearly associated with a better long-term clinical outcome. Simple baseline variables can predict the improvement of cardiac function after reperfused AMI.

Electrical and mechanical predictors in response to cardiac resynchronisation therapy

Results: Responders were 27 (20M-7F; 60%) and CRT improved IMVD (p 400 msc and Q-S delay >65 msc between two basal segments selected the patient who will benefit of CRT. Background and purpose: Cardiac resynchronization therapy (CRT) was shown to reverse left ventricular (LV) remodeling in patients with congestive heart failure (CHF). The prediction of LV function im- provement was demonstrated for intraventricular and interventricular asynchrony degree, evaluated by tissue Doppler imaging echocardiog- raphy. The aim of the study was to investigate whether intraoperative electrocardiographic (ECG) and electrophysiological (EP) parameters were also predictive factors of LV reverse remodeling after CRT. Methods and results: Forty-nine patients with CHF were implanted with resynchronization devices. During procedure, several ECG and EP parameters were evaluated without pacing, with fight ventricular pacing (RVp), LV pacing (LVp) and biventricular pacing (Bp). At follow-up (mean 9 months) responders (n=27) were defined by a relative increase in LV ejection fraction more or equal than 25% compared with baseline. Several ECG and EP parameters, evaluating electrical asynchrony during LVp or RVp, were shown to predict LV reverse remodeling. Receiver operating curve analysis revealed the ratio of QRS width during BP and RVp (Bp/RVp index) as the best predictor of LV functional recovery after resynchronization (area under the curve=0.82). The value of the Bp/RVp index with the best predictive accuracy resulted 0.78. The Bp/RVp index correlated significantly with the improvement of LV ejection fraction (r= -0.49, p<0.005) at follow-up and with LV free wall activation time relative to QRS (r= -0.52, p<0.005). Clinical and

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion. We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI). In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase > or = 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion. Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = -0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade > or = 2 and ST-segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade > or = 2 showed the better negative likelihood ratio, and ST-segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery. Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG > or = 2 and ST-segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.

Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function

ObjectivesThe aim of this study was to determine whether the extent of viability or scar is important in the amount of recovery of left ventricular (LV) function, and to develop a model for predicting recovery after revascularization that could be tested in a randomized trial. BackgroundF-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is used to define viable myocardium in patients with coronary artery disease (CAD) and severe LV dysfunction and to guide revascularization decisions. Whether this approach improves clinical outcomes has not been tested in a randomized trial. Before doing so, an objective model for prediction of recovery is required. MethodsA total of 82 patients with CAD and an ejection fraction (EF) ≤35% had FDG PET perfusion imaging before revascularization. Complete follow-up was available on 70 patients (86%). Patients had radionuclide angiograms at baseline and three months post-revascularization. ResultsDiabetes (p = 0.029), time to operation (p = 0.008), and scar score (p = 0.001) were significant independent predictors of the change in EF. Previous coronary artery bypass graft confounded the effect of age. There was a significant interaction between the perfusion tracer used and mismatch score (p = 0.02). The multivariable prediction model incorporating PET and clinical variables had a goodness of fit with p = 0.001. Across tertiles of scar scores (I, small: 0% to 16%; II, moderate: 16% to 27.5%; III, large: 27.5% to 47%), the changes in EFs were 9.0 ± 1.9%, 3.7 ± 1.6%, and 1.3 ± 1.5% (p = 0.003: I vs. III), respectively. ConclusionsIn patients with severe LV dysfunction, the amount of scar was a significant independent predictor of LV function recovery after revascularization. A combination of PET and clinical parameters predicts the degree of recovery. This model is being applied in a large randomized controlled trial to determine the effectiveness of therapy guided by FDG PET.

Dobutamine Magnetic Resonance Imaging Predicts Contractile Recovery of Chronically Dysfunctional Myocardium After Successful Revascularization

Objectives. This study sought to evaluate whether myocardial viability, as assessed by magnetic resonance imaging (MRI), reliably predicts postrevascularization left ventricular (LV) recovery.Background. Compared with positron emission tomographic findings, MRI has proved to be a reliable technique for the identification of residual myocardial viability. However, the predictive accuracy of MRI-assessed preserved end-diastolic wall thickness (DWT) and dobutamine-induced systolic wall thickening (SWT) for LV functional recovery has not yet been evaluated.Methods. Rest and low dose dobutamine MRI was performed in 43 patients with a chronic infarct (≥4 months since ischemic event) and LV dysfunction who had undergone revascularization of the infarct-related vessel. On the basis of segmental evaluation of corresponding short-axis tomograms, infarct regions were graded viable by MRI if 1) DWT was ≥5.5 mm, and 2) dobutamine-induced SWT was ≥2 mm in ≥50% of dysfunctional segments related to the infarct region. Functional recoverywas defined as SWT ≥2 mm in ≥50% of infarct-related segments at rest 4 to 6 months after successful revascularization.Results. Recovery of regional SWT could be observed in 27 (63%) of 43 patients. Comparison MRI grading before and after revascularization indicated that dobutamine-induced SWT was a better predictor of LV functional recovery (sensitivity 89%, specificity 94%) than was preserved DWT (sensitivity 92%, specificity 56%). Segments that remained akinetic after revascularization had significantly lower DWT (6.0 ± 3.1 mm [n = 219] vs. 9.8 ± 2.6 mm [n = 188], p < 0.001) than those with improved SWT. Left ventricular ejection fraction increased significantly in patients with dobutamine-induced SWT than in those with no contractile reserve (14 ± 9% vs. 3 ± 9%, p < 0.0002), and the magnitude of this increase was correlated with the number of dobutamine-responsive segments per infarct region (r = 0.68, p < 0.0001).Conclusions. Quantitative assessment of dobutamine-induced SWT in chronic infarcts by MRI is a highly accurate predictor of LV functional recovery, and the presence of significantly reduced DWT reliably indicates irreversible myocardial damage. Therefore, dobutamine stress testing for the assessment of myocardial viability can be restricted to patients with preserved DWT.