Key result
Peak left ventricular torsion assessed early after primary PCI for acute myocardial infarction independently predicted left ventricular remodeling at 6 months (β 0.27; 95% CI 0.15-0.5; P=0.001).
Why the study?
Does early assessment of left ventricular torsion by 2D speckle tracking predict left ventricular remodeling at 6 months in patients undergoing primary PCI for acute myocardial infarction?
Cohort (n=115)
No
Does early assessment of left ventricular torsion by 2D speckle tracking predict left ventricular remodeling at 6 months in patients undergoing primary PCI for acute myocardial infarction?
Effect estimate: β 0.27 (95% CI 0.15-0.5)
Absolute Event Rate: 7.56% vs 15.16%
p-value: p=0.001
Impaired left ventricular torsion assessed by 2D speckle tracking echocardiography early after primary PCI for acute myocardial infarction is an independent predictor of subsequent LV remodeling at 6 months.
Early LV torsion assessment may identify post-PCI remodeling risk; hypothesis-generating and requires prospective validation before practice change.
AIMS: Left ventricular (LV) torsion is a novel method to assess systolic LV function. This study aimed at exploring the utility of 2D speckle tracking-based assessment of left ventricular torsion in patients with acute myocardial infarction (AMI) undertaking primary percutaneous intervention (pPCI) in predicting left ventricular remodeling. METHODS AND RESULTS: The study included 115 patients (mean±SD, age 52.2±9.67, males 84.3%) who underwent pPCI for AMI. Echocardiographic assessment of LV torsion by two-dimensional speckle tracking was performed early after the index pPCI. Patients underwent repeat echocardiography at 6 months to detect remodeling. LV torsion in the acute setting was significantly lower in those who demonstrated LV remodeling at follow-up compared to those without remodeling (7.56±1.95 vs 15.16±4.65; P<.005). Multivariate analysis identified peak CK & CK-MB elevation (β=-0.767 and -0.725; P<.001), SWMA index (β=-0.843; P<.001), and Simpson's derived LV ejection fraction (LVEF; β=0.802; P<.001) as independent predictors of baseline LV torsion. It also identified peak LV torsion (β: 0.27; 95% CI: 0.15-0.5, P=.001) and SWMA index (β: 1.07, 95% CI: 1.03-1.12, P=.005) as independent predictors of LV remodeling. Baseline Killip's grades II and higher (β: 48.6; 95% CI 5.5-428, P<.001) and diabetes mellitus (β: 29.7; 95% CI 1.1-763, P<.05) were independent predictors of mortality. CONCLUSION: Left ventricular torsion in acute MI setting is impaired and predicts subsequent LV remodeling at 6-month follow-up.
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Awadalla et al. (2017) conducted a cohort in Acute myocardial infarction (AMI) (n=115). Left ventricular torsion assessed by 2D speckle tracking was evaluated on Left ventricular remodeling (β 0.27, 95% CI 0.15-0.5, p=0.001). Peak left ventricular torsion assessed early after primary PCI for acute myocardial infarction independently predicted left ventricular remodeling at 6 months (β 0.27; 95% CI 0.15-0.5; P=0.001).
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