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0421: End-systolic wall stress to predict left ventricular remodeling after acute myocardial infarction

Elsevier France
DOI: 10.1016/s1878-6480(14)71417-x
  • Medicine


Objectives to investigate whether the end-systolic wall stress is a predictor of left ventricular remodeling (LVR) in the aftermath of a myocardial infarction. Background LVR in post myocardial infarction is hard to predict and associated with major adverse cardiovascular events. Methods we calculate, among other parameters, end-systolic wall stress by three-dimensional MRI method in the aftermath of a revascularized MI. CMR was repeated at 3 months follow-up. Results The analysis was performed on 169 patients. 13 patients presented LVR, including 11 due to anterior MI. In these 13 patients the data of the initial MRI were more pejorative: WS 25.9±6 vs 16.0±4 (p <0.001), LVEDVi 117.2±20ml/m2 vs 84.6±16ml/m2 (p<0.001), infarct size 46.6±20gr vs 22.8 ± 15gr (p<0.001), microvascular obstruction size 8.7±1.9gr vs 9±3gr (p<0.001) and LV ejection fraction 31.0±8% vs 49.0±9% (p<0.001). The initial global WS emerges as an independent predictor of LV remodeling (OR 1.298 [1.046 to 1.612], p<0.018) so as LVEDVi (OR 1.093 [1.013 to 1.180], p<0.022) and heart failure (OR 9.912 [1.094 to 89.842], p<0.041). Of note, LVEF so as infarct and obstruction microvascular size were not independent predictors. Patients with an initial global WS below 20.88·103 Nm-2 will not present LVR in 98.5% of cases (sensitivity and specificity of 84.6%). Conclusion end-systolic wall stress is an independent predictor of LV remodeling in post-MI. Patients with an initial global WS below 20,88·103 Nm-2 presented a small risk for LVR.

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