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Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion

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Abstract

Reverse left ventricular (LV) remodeling (>10 % reduction in LV end-systolic volume) may occur in patients recovering for acute ST-elevation myocardial infarction (STEMI), undergoing percutaneous revascularization of infarct-related coronary artery (PCI). To detect whether LV global torsion obtained by two-dimensional speckle-tracking echocardiography was predictive of reverse LV remodeling, 75 patients with first anterior wall STEMI were studied before (T1) and after PCI (T2) and at 6-month follow-up. Two-year clinical follow-up was also accomplished. LV volumes and both LV sphericity index and conic index were obtained by three-dimensional echocardiography. Reverse remodeling was observed in 25 patients (33 %). By multivariate analysis, independent predictors of reverse LV remodeling were: LV conic index, T2 LV torsion and Δ torsion (difference between T2 and T1 LV torsion expressed as percentage of this latter). According to receiver operating characteristic analysis, 1.34°/cm for T2 LV torsion (sensitivity 88 % and specificity 80 %) and 54 % for Δ torsion (sensitivity 92 % and specificity 82 %) were the optimal cutoff values in predicting reverse LV remodeling. In up to 24 month follow-up, 4 non-fatal re-infarction, 7 hospitalization for heart failure and 4 cardiac deaths occurred. By multivariate Cox analysis, the best variable significantly associated with event-free survival rate was reverse LV remodeling with a hazard ratio = 9.9 (95 % confidence interval, 7.9–31.4, p < 0.01). In conclusion, reverse LV remodeling occurring after anterior wall STEMI is associated with favorable long-term outcome. The improvement of global LV torsion following coronary artery revascularization is the major predictor of reverse LV remodeling.

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Authors and Affiliations

  1. Department of Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy

    Letizia Spinelli, Carmine Morisco, Emiliano Assante di Panzillo, Raffaele Izzo & Bruno Trimarco

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  1. Letizia Spinelli
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  2. Carmine Morisco
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  3. Emiliano Assante di Panzillo
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  4. Raffaele Izzo
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  5. Bruno Trimarco
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Correspondence to Letizia Spinelli.

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Spinelli, L., Morisco, C., Assante di Panzillo, E. et al. Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion. Int J Cardiovasc Imaging 29, 787–795 (2013). https://doi.org/10.1007/s10554-012-0159-5

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  • DOI: https://doi.org/10.1007/s10554-012-0159-5

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