Department of Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Int J Cardiovasc Imaging. 2013 Apr;29(4):787-95. doi: 10.1007/s10554-012-0159-5. Epub 2012 Nov 22.
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.
左心室（LV）逆向重构（LV 收缩末期容积减少>10%）可能发生于接受经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高型心肌梗死（STEMI）患者。为了检测二维斑点追踪超声心动图获得的 LV 整体扭转是否可预测 LV 逆向重构，研究了 75 例前壁首次 STEMI 患者，分别于 PCI 前（T1）、PCI 后（T2）和 6 个月随访时进行检查，并完成了 2 年的临床随访。通过三维超声心动图获得 LV 容积及 LV 球形指数和圆锥指数。25 例（33%）患者出现 LV 逆向重构。多变量分析显示，LV 圆锥指数、T2LV 扭转和Δ扭转（T2 和 T1 LV 扭转之间的差异，以 T1 LV 扭转的百分比表示）是 LV 逆向重构的独立预测因素。根据受试者工作特征分析，T2LV 扭转 1.34°/cm（敏感性 88%，特异性 80%）和Δ扭转 54%（敏感性 92%，特异性 82%）是预测 LV 逆向重构的最佳截断值。在 24 个月的随访中，发生了 4 例非致死性再梗死、7 例心力衰竭住院和 4 例心脏性死亡。多变量 Cox 分析显示，与无事件生存率显著相关的最佳变量是 LV 逆向重构，风险比=9.9（95%置信区间，7.9-31.4，p<0.01）。总之，前壁 STEMI 后发生的 LV 逆向重构与良好的长期预后相关。冠状动脉血运重建后 LV 整体扭转的改善是预测 LV 逆向重构的主要因素。
