Left ventricular twist during dobutamine stress echocardiography after acute myocardial infarction: association with reverse remodeling

Left ventricular (LV) twist is emerging as a marker of global LV contractility after acute myocardial infarction (AMI). This study aimed to describe stress- induced changes in LV twist during dobutamine stress echocardiography (DSE) after AMI and investigate their association with LV reverse remodeling at 6 months follow-up. In 82 consecutive first AMI patients (61±12 years, 85 % male) treated with primary percutaneous coronary intervention, DSE was performed at 3 months follow-up. Two-dimensional speckle-tracking-derived apical and basal rotation and LV twist were calculated at rest, low- and peak- dose stages. LV reverse remodeling was defined as C 10 % decrease in LV end-systolic volume between baseline and 6 months follow-up. Patterns of LV twist response on DSE consisted of either a progressive increase throughout each stage (n=18), an increase at either low- or peak-dose (n = 53) or no significant increase (n =11). LV reverse remodeling occurred in 28 (34 %) patients, who showed significantly higher peak-dose LV twist (8.51° vs. 6.69°, p =0.03) and more frequently progressive LV twist increase from rest to peak-dose (39 vs. 13 %, p \0.01) compared to patients without reverse remodeling. Further- more, increase in LV twist from rest to peak-dose was the only independent predictor of LV reverse remodeling at 6 months follow-up (OR 1.3, 95 % CI 1.1-1.5, p = 0.005). Both the pattern of progressive increase in LV twist and the stress-induced increment in LV twist on DSE are significantly associated with LV reverse remodeling at 6 month follow-up after AMI, suggesting its potential use as a novel marker of contractile reserve.Emer Joyce, Darryl P. Leong, Georgette E. Hoogslag, Paul L. van Herck, Philippe Debonnaire, Elena Abate, Eduard R. Holman, Martin J. Schalij, Jeroen J. Bax, Victoria Delgado, Nina Ajmone Marsa