Analysis of left ventricular changes after acute myocardial infarction using transthoracic real-time three-dimensional echocardiography

Background: Little information is available regarding the relationship between three-dimensional (3-D) echocardiographic parameters in acute stage of acute myocardial infarction (AMI) and subsequent left ventricular (LV) remodeling after AMI. Methods: Consecutive patients with AMI were analyzed for echocardiographic predictors of subsequent LV remodeling after AMI using two-dimensional (2-D) echocardiography and real-time 3-D echocardiography at baseline and month 3 of follow-up. LV adverse and favorable remodeling were defined as a >10% and ≤10% increase in 3-D derived LV end diastolic volume index (LVEDVI) at 3 months' follow-up compared with baseline, respectively. Results: 19 AMI patients underwent real-time 3-D echocardiography at baseline and at 3 months after AMI. In patients with favorable remodeling (n = 12), baseline, LVEDVI, LV end-systolic volume index (LVESVI) and LV stroke volume index (LVSVI) were significantly increased compared with patients with adverse remodeling. At 3 months of follow-up, patients with favorable remodeling had significant 3-D LVEDVI, LVESVI, and systolic sphericity index reductions compared to patients with adverse remodeling in which these variables were increased. Baseline clinical and echocardiographic variables were analyzed for the identification of favorable LV remodeling. Of these, LVESVI was the most predictive variable with sensitivity, specificity, and positive and negative predictive values for a cutoff value of >42 mL/m² of 75%, 71%, 75%, and 71%, respectively. Conclusions: LVESVI assessed by 3-D echocardiography was the most predictive parameter indicating favorable LV remodeling after AMI. LV shape on contraction changed from elliptical shape to more globular in the adverse remodeling process after AMI.