Left ventricular torsion assessed by two-dimensional echocardiography speckle tracking as a predictor of left ventricular remodeling and short-term outcome following primary percutaneous coronary intervention for acute myocardial infarction: A single-center experience

Aims: Left ventricular (LV) torsion is a novel method to assess systolic LV function. This study aimed at exploring the utility of 2D speckle tracking-based assessment of left ventricular torsion in patients with acute myocardial infarction (AMI) undertaking primary percutaneous intervention (pPCI) in predicting left ventricular remodeling. Methods and Results: The study included 115 patients (mean +/- SD, age 52.2 +/- 9.67, males 84.3%) who underwent pPCI for AMI. Echocardiographic assessment of LV torsion by two-dimensional speckle tracking was performed early after the index pPCI. Patients underwent repeat echocardiography at 6 months to detect remodeling. LV torsion in the acute setting was significantly lower in those who demonstrated LV remodeling at follow-up compared to those without remodeling (7.56 +/- 1.95 vs 15.16 +/- 4.65; P<.005). Multivariate analysis identified peak CK & CK-MB elevation (beta=-0.767 and -0.725; P<.001), SWMA index (beta=-0.843; P<.001), and Simpson's derived LV ejection fraction (LVEF; beta=0.802; P<.001) as independent predictors of baseline LV torsion. It also identified peak LV torsion (beta: 0.27; 95% CI: 0.15-0.5, P=.001) and SWMA index (beta: 1.07, 95% CI: 1.03-1.12, P=.005) as independent predictors of LV remodeling. Baseline Killip's grades II and higher (beta: 48.6; 95% CI 5.5-428, P<.001) and diabetes mellitus (beta: 29.7; 95% CI 1.1-763, P<.05) were independent predictors of mortality. Conclusion: Left ventricular torsion in acute MI setting is impaired and predicts subsequent LV remodeling at 6-month follow-up.