Objectives: Following acute myocardial infarction (AMI) left ventricular ( LV ) remodelling comprises infarct expansion, LV dilatation, and hypertrophy.It can start soon after AMI and, if not attenuated or reversed by intervention, leads to heart failure and increased mortality. Among several diagnostic modalities two-dimensional echocardiography(2DE) plays very important role. This study was designed to unravel the role of conventional echocardiography to evaluate the LV remodelling following AMI.
Methods: We enrolled 36 patients (Age,59±11yrs;Male,11) with first attack of AMI without cardiogenic shock or gross heart failure. Patients were classified on the basis of the timing of coronary intervention, and ST-T change.All patients underwent percutaneous coronary intervention(PCI).2DE was performed just after admission, and at 3 months interval.Ejection fraction(EF),wall motion score index(WMSI),end diastolic volume index(EDVI),and end systolic volume index(ESVI)were calculated. Increasing EDVI by =15% at 3 months was considered as remodeling.
Results: Fifteen patients (42%) showed LV remodelling. Initial LVEDVI and LVESVI were significantly lower in patients with remodelling in comparison with patients without remodelling (p<0.0001; 95%CI,-22.73to-11.75 and p<0.001;95%CI,-13.27to-4.04 respectively). Patients with ST-segment elevation myocardial infarction(STEMI)showed higher rate of remodelling (45%)than that of NSTEMI(37.5%);On the other hand patients underwent emergency PCI showed higher rate of remodelling(47.82%)than those underwent delayed intervention (30.76%).WMSI and EF showed significant correlation with the LVEDVI at 3 months(r= 0.53,p<0.0007;r=-0.48,p<0.002 respectively).
Conclusions: Conventional echocardiography is very convenient approach to evaluate the ongoing LV remodelling following successfully reperfused AMI. Moreover more emphasis should be given to patients with initially low LVEDVI so that preventive measures of can be taken within shortest possible time.