Abstrakt
Ratio E/E' and culprit artery predict ventricular remodeling after STEMI.
Muratalla-González R1, Zaldivar-Fujigaki JL2, Van Der Harst P3, Aceves Chimal JL4, Morales- Portano JD1, GarcÃa-GarcÃa JF1, Merino-Rajme JA1*
Background: ST-Elevation Myocardial Infarction (STEMI) is one of the most severe manifestations of atherosclerosis; prognosis is determined by remaining left ventricular function and the importance of systolic function has been well established. The aim of this study was to determine the E/E’ ratio, to predict the adverse ventricular remodeling (VR) in patients presenting with STEMI. Methods: From March 2011 to January 2012 we prospectively enrolled patients presenting with STEMI in the admission unit. Echocardiography was performed at presentation and 6 months after STEMI. VR was defined as the increase ≥ 20% of the left ventricular end diastolic volume. Uni and multivariate linear regression analyses were conducted. Results: Sixty-six STEMI patients (60.8 ± 10.3 years, 81% male) were recruited. In 56% the culprit artery was left anterior descending (LAD), right coronary artery in 39% and circumflex in 5%. VR was predicted by LAD as culprit artery (92%, p<0.001, rho 0.528), Septal E’ Velocity (p<0.001, rho 0.370) and the ratio E/E’ (p<0.001, -0.663). Six months after the STEMI patients with VR had lower left ventricular ejection fraction, and higher end systolic and diastolic volume. ROC analysis suggested an optimal cutoff for a E/E' ratio of ≥ 12 (S:91%, E:77%) at baseline to predict adverse VR. Multivariate analysis showed that the ratio E/E’, septal E´ velocity, culprit artery, and Killip Kimbal classification were predictors of adverse VR after STEMI (rho 0.750). Conclusion: E/E´ ratio ≥ 12 and LAD as the culprit artery are important predictors for adverse ventricular remodeling and should be considered for early medical treatment.