Predictors of Adverse Left Ventricular Remodeling and Final Infarct Size After Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: A Strain Analysis Study Using Echocardiography and Feature Tracking Cardiac Magnetic Resonance
Predictors of Adverse Left Ventricular Remodeling and Final Infarct Size After Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: A Strain Analysis Study Using Echocardiography and Feature Tracking Cardiac Magnetic Resonance
NCT ID: NCT04773652 Phase: Status: COMPLETED Enrollment: 80 Completion: 2022-08-31
Conditions
ST Elevation Myocardial Infarction, Remodeling, Left Ventricle
Interventions
speckle tracking echo
Summary
ST-segment elevation myocardial infarction (STEMI) is one of the most important causes of death and disability around the world.
The main goal in the management of acute myocardial infarction (AMI) is early restoration of coronary artery flow in order to preserve viable myocardium. Primary percutaneous coronary intervention (PCI) has proven to be superior to other reperfusion strategies in terms of mortality reduction and preservation of left ventricular (LV) function. Despite improvements in the treatment of MI, 30% of patients show LV remodeling post-MI. Over time, remodeling adversely affects cardiac function and can lead to significant morbidity and mortality. Early risk stratification is essential to identify patients who will benefit from close follow-up and intense medical therapy.
The most widely investigated functional left ventricular (LV) characteristic to predict patient outcome after STEMI is LV ejection fraction (LVEF). Several structural LV characteristics have also shown to be important predictors of cardiovascular adverse events and death, including LV end diastolic volume (LVEDV), end systolic volume (LVESV) and mass (LVM).
Cardiovascular magnetic resonance (CMR) imaging is the current reference standard for assessing ventricular volumes and mass. Adverse remodeling results from an inability of the heart to maintain geometry post MI in the context of large infarcts and increased wall stresses.
The compensatory hypertrophic response of the remote non-infarcted myocardium (end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT)) might also play an important role in the remodeling after myocardial infarction but this needs to be investigated.
Infarct size -as a crucial endpoint for adverse remodeling- is influenced by several factors: - the size of the area at risk (AAR) (myocardium supplied by the culprit vessel); residual flow to the ischemic territory (e.g., collateral flow); myocardial metabolic demand; and the duration of
Primary Outcome
Comparing the predictive ability of 2D, 3D speckle tracking echo and feature tracking CMR for adverse remodeling and final infarct size after STEMI