Left Ventricular Diastolic Dyssynchrony in Post-Myocardial Infarction Patients: Does It Predict Future Left Ventricular Remodeling?

Abstract

Left ventricular (LV) remodeling is well-known complication after myocardial infarction (MI) and numerous studies have emphasized the clinical importance of ventricular remodeling. In these literatures, progressive LV dilatation and decreased LV ejection fraction were major determinants in future development of heart failure and long term survival. That is why early recognition of patients at risk for LV remodeling after MI has vital importance and identification of the predictive markers for developing ventricular remodeling is clinically meaningful. While the clinical importance of LV mechanical dyssynchrony is mainly described in heart failure patients, its significance in patients with MI was less well established. Actually, ventricular dyssynchrony is not uncommon in post-MI patients even with narrow QRS complexes. Zhang et al. and Fahmy Elnoamany et al. noted LV systolic dyssynchrony early after MI in 69.8% and 77.5% of the patients and it was mainly determined by the initial infarct size. After that, various parameters from tissue Doppler imaging and speckletracking technique have been used for detecting regional contraction and relaxation abnormalities and LV systolic and diastolic dyssynchrony early after MI. Several studies demonstrated that LV systolic dyssynchrony in post-MI patients is closely related with future LV remodeling and poor prognosis. Mollema et al. showed that patients with more extensive LV dyssynchrony at baseline have larger LV end systolic volume after 6 months of follow up and increased risk of LV remodeling. Similar results were showed by Zhang et al. that LV systolic dyssynchrony increased with worsening LV pISSN 1975-4612/ eISSN 2005-9655 Copyright © 2016 Korean Society of Echocardiography www.kse-jcu.org http://dx.doi.org/10.4250/jcu.2016.24.3.193