1. Left Ventricular Dyssynchrony Acutely After Myocardial Infarction Predicts Left Ventricular Remodeling Sjoerd A. Mollema 1, Su San Liem 1, Matthew S. Suffoletto 3, Gabe B. Bleeker 1, Bas L. van der Hoeven 1, Nico R. van de Veire 1, Eric Boersma 2, Eduard R. Holman 1, Ernst E. van der Wall 1, Martin J. Schalij 1, John Gorcsan III 3, Jeroen J. Bax 1 1 LUMC (Cardiology), Leiden, The Netherlands 2 Erasmus MC (Statistics), Rotterdam, The Netherlands 3 The Cardiovascular Institute, Pittsburgh, USA J Am Coll Cardiol 2007;50:1532-40

2. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Introduction LV remodeling after AMI → adverse long-term prognosis 1 Early identification → optimize therapeutic management Early identification: baseline predictor 1 White et al, Circulation 1987; 76(1): 44-51

3. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Objectives To identify baseline predictors of long- term LV remodeling after acute myocardial infarction Early identification of patients prone to LV remodeling in order to optimize therapeutic management

4. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Methods All patients (n=178) underwent primary PCI for acute myocardial infarction 2D-Echocardiography was performed <48 h of admission & at 6 month FUP LV dyssynchrony was quantified using speckle-tracking radial strain analysis. Time-strain curves of a patient without (left panel) and with (right panel) dyssynchrony at baseline are demonstrated.

5. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Results Median LV dyssynchrony was significantly higher (p <0.001) in patients with LV remodeling versus without LV remodeling.

6. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Results Distribution of latest activated LV segments in patients with LV remodeling.

7. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Results Correlation between LV dyssynchrony at baseline and LV end-systolic volume (left panel) and change in LV end-systolic volume (right panel) at 6-month FUP.

8. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Results Extent of LV dyssynchrony according to changes in LV end-systolic volume during FUP.

9. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Results ROC curve analysis to determine the optimal cutoff value for LV dyssynchrony to predict LV remodeling.

10. Copyright ©2007 American College of Cardiology Foundation. Restrictions may apply. J Am Coll Cardiol 2007;50:1532-40Conclusions 1.Patients with LV remodeling demonstrate: - ↑ baseline peak levels of cardiac enzymes - ↑ WMSI - ↑ E/E’ ratio - ↑ extent of LV dyssynchrony 2.Baseline LV dyssynchrony of ≥130 ms → sensitivity of 82% and specificity of 95% to predict LV remodeling at 6 months after AMI 3.Optimization of therapeutic management in patients with severe LV dyssynchrony early after AMI might be beneficial: - further pharmacologic optimization? - early use of CRT?