Abstract 19105: Response in Left Ventricular Twist During Dobutamine Stress Echocardiography After ST-segment Elevation Myocardial Infarction Predicts Reverse Remodeling
PURPOSE Left ventricular (LV) twist, an emerging marker of global LV function, has not been evaluated during full-protocol dobutamine stress echocardiography (DSE) in patients following ST-segment elevation myocardial infarction (STEMI).
HYPOTHESIS We aimed to evaluate if the response of LV twist during DSE could predict follow-up LV reverse remodeling.
METHODS Consecutive patients admitted with first STEMI undergoing primary percutaneous coronary intervention, standard protocol DSE at 3 months and 2-dimensional echocardiographic studies at baseline (48 hours) and follow-up (6-months) were selected. DSE studies positive for ischemia were excluded. Speckle-tracking analysis was used to calculate LV twist - defined as the net difference (in degrees) between apical and basal rotation at isochronal time points -at each stage. LV reverse remodeling was defined as a ≥10% decrease in LV end-systolic volume at follow-up.
RESULTS In total, 82 patients (mean age 61 ± 12 years, 85% male, mean LVEF 49 ± 9%) had complete DSE studies feasible for speckle-tracking. Overall LV reverse remodeling occurred in 28 (34%) patients, who showed significantly higher peak-stress LV twist (8.51° versus 6.69°, p=0.01) (Figure). On univariate analysis, baseline LVEF (p=0.03), family history of CAD (p=0.05) and the increase in LV twist from rest to peak stress (p=0.005) were significantly related to LV reverse remodeling; however only LV twist increase remained independently related on multivariate analysis (OR 1.3, 95% CI 1.1-1.5, p=0.005). The ability of LV twist increase to predict reverse remodeling remained significant for subgroup analysis of patients with LV ejection fraction <50%. (OR 1.62, 95% CI 1.1 - 2.3, p=0.01).
CONCLUSIONS The increase in LV twist from rest to peak-stress on 3-month DSE in post-STEMI patients independently predicts 6-month LV reverse remodelling, suggesting a novel, clinical use for LV twist as a marker of contractile reserve.
- © 2012 by American Heart Association, Inc.