Morphofunctional picture of the left ventricle in different variants of post-infarction remodeling

Objective. To study morphofunctional characteristics of the myocardium in patients with different variants of LV remodeling 24 weeks after myocardial infarction and revascularization. Material and methods. A total of 105 patients with myocardial infarction were included. Primary percutaneous coronary intervention was performed in 67 (63.8%) patients, pharmacoinvasive revascularization in 38 (36.2%) patients. Cardiac magnetic resonance imaging (MRI), speckle tracking echocardiography (EchoCG) were performed on the 7th—10th day and after 24 weeks. Results. Follow-up was completed for 92 (87.6%) patients. According to EchoCG results, patients were divided into groups: 1 — 44 patients with increased end-diastolic volume index (iEDV) >20% and/or end-systolic volume index (iESV) >15% after 24 weeks (pathological remodeling (PR) of the LV); 2 — 27 patients with iEDV <20% in combination with dynamics of iESV from -15% to +15% (slowly progressive remodeling (SR) of the LV); 3 — 21 patients with regression of iESV≥15% (reverse remodeling (RR) of the LV). According to cardiac MRI, scar mass in the PRLV group decreased by 4.8% (p=0.005), SRLV — by 48.2% (p=0.017), RRLV — by 44.4% (p=0.040). The incidence of microvascular obstruction decreased with SRLV by 2.7 times (p=0.006). According to EchoCG after 24 weeks, the RRLV group was characterized by global work efficiency increase by 2.7% (p=0.021), global work index by 28.1% (p<0.001), and global constructive work by 27.3% (p<0.001). These parameters did not change in comparison groups. Conclusion. Cardiac MRI and speckle-tracking EchoCG allow quantitative assessment of morphofunctional picture of postinfarction cardiac sclerosis. Cardiac MRI revealed shrinkage of infarction zones that was most pronounced in the SRLV group. In the RRLV group, speckle-tracking EchoCG revealed favorable increase in myocardial work indicators.