Ventricular-arterial uncoupling as early marker of unfavorable left ventricular remodeling in patients with myocardial infarction

Aim

To evaluate the relationship of unfavorable left ventricular (LV) remodeling with the left ventricular-arterial coupling (VAC) in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI).

Material and methods

We used two-dimensional echo cardiography to assess arterial elastance (Ea) and end-systolic LV elastance (Ees) on admission and at 6 months in 112 patients with MI and PCI (68% male, age 61.1±9.5 years). VAC was calculated as Ea/Ees ratio. Cardiac remodeling was defined as an increase of LV end-diastolic and/or end-systolic volume by more than 20% compared with baseline.

Results

At baseline, all patients had left ventricular ejection fraction (LV EF) >40% while VAC was in optimal range (0.5-1.2). At 6 months, VAC ≥1.2 was found in 67 (60%) patients, and unfavorable LV remodeling was present in 81 (72%) patients. Achieved VAC ≥1.2 was associated with adverse cardiac remodeling (odds ratio 6.16; 95% confidence interval 2.47-15.37; p<0.0005). A significant correlation was found between LV remodeling and VAC after 6 months (r=0,41; p <0,05).

Conclusion

Increased VAC indicating LV-arterial uncoupling may be an early marker of unfavorable LV remodeling.

Key words

.Myocardial infarction, adverse left ventricular remodeling, ventricular-arterial coupling.