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

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.

Usefulness of satisfactory control of low-density lipoprotein cholesterol to predict left ventricular remodeling after a first ST-elevation myocardial infarction successfully reperfused.

Left ventricular (LV) remodeling represents an important determinant in the progression to heart failure in patients after myocardial infarction. The aim of the present study was to evaluate in patients with first ST-segment elevation acute myocardial infarction who were successfully and completely reperfused whether the control of cholesterol is predictive of LV remodeling. A total of 109 patients referred to a coronary care unit for first ST-segment elevation myocardial infarction were analyzed. According to the change in indexed LV end-diastolic volume detected at follow-up visits, patients were divided into nonremodeling (n = 79) and remodeling (n = 30) groups. At coronary care unit admission, the prevalence of cardiovascular risk factors was similar in the 2 groups. Low-density lipoprotein (LDL) cholesterol values were used as criteria for cholesterol control. At follow-up visits, the prevalence of patients with target levels of plasma LDL cholesterol was lower in the remodeling compared to the nonremodeling group (67% and 91%, respectively, p <0.01). After adjusting for age, gender, baseline LV ejection fraction, baseline indexed LV end-diastolic volume, hypertension, diabetes, obesity, smoking status, time from acute event, drugs (ß blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and statins), wall motion score index, and troponin levels, logistic regression analysis showed that patients with nontarget LDL cholesterol values at follow-up were significantly more likely to show cardiac remodeling (odds ratio 22.3, 95% confidence interval 2.91 to 171.9, p = 0.003). In conclusion, the present study shows that unsatisfactory control of LDL cholesterol independently predicts LV remodeling in patients with first ST-segment elevation myocardial infarction.

G protein-coupled receptor kinase 2 in patients with acute myocardial infarction.

Lymphocyte G protein-coupled receptor kinase 2 (GRK2) levels are increased in patients with chronic heart failure, and in this condition, they correlate with cardiac function. The aim of this study was to assess the prognostic role of GRK2 during acute cardiac dysfunction in humans. A study was designed to investigate the role of GRK2 levels in patients with acute coronary syndromes. Lymphocyte GRK2 levels were examined at admission and after 24 and 48 hours in 42 patients with acute coronary syndromes, 32 with ST-segment elevation myocardial infarction and 10 with unstable angina as a control group. Echocardiographic parameters of systolic and diastolic function and left ventricular remodeling were evaluated at admission and after 2 years. GRK2 levels increased during ST-segment elevation myocardial infarction and were associated with worse systolic and diastolic function. This association held at 2-year follow-up, when GRK2 was correlated with the ejection fraction and end-systolic volume, indicating a prognostic value for GRK2 levels during acute ST-segment elevation myocardial infarction. In conclusion, lymphocyte GRK2 levels increase during acute myocardial infarction and are associated with worse cardiac function. Taken together, these data indicate that GRK2 could be predictive of ventricular remodeling after myocardial infarction and could facilitate the tailoring of appropriate therapy for high-risk patients.