Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.

OBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND LVAR, usually defined as an increase...

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Autores: Rodriguez-Palomares, Jose F, Gavara, Jose, Ferreira-Gonzalez, Ignacio, Valente, Filipa, Rios, Cesar, Rodriguez-Garcia, Julian, Bonanad, Clara, Garcia Del Blanco, Bruno, Minana, Gema, Mutuberria, Maria, Nunez, Julio, Barrabes, Jose, Evangelista, Artur, Bodi, Vicente, Garcia-Dorado, David
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p3657
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/3657
Access Level:acceso abierto
Palabra clave:cardiac magnetic resonance
infarct size
left ventricular ejection fraction
left ventricular end-diastolic volume
left ventricular end-systolic volume
left ventricular remodeling
microvascular obstruction
prognosis
ST-segment elevation myocardial infarction
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spelling Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.Rodriguez-Palomares, Jose FGavara, JoseFerreira-Gonzalez, IgnacioValente, FilipaRios, CesarRodriguez-Garcia, JulianBonanad, ClaraGarcia Del Blanco, BrunoMinana, GemaMutuberria, MariaNunez, JulioBarrabes, JoseEvangelista, ArturBodi, VicenteGarcia-Dorado, Davidcardiac magnetic resonanceinfarct sizeleft ventricular ejection fractionleft ventricular end-diastolic volumeleft ventricular end-systolic volumeleft ventricular remodelingmicrovascular obstructionprognosisST-segment elevation myocardial infarctionOBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. METHODS Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 +/- 2.6 days) and after 6 months (6.1 +/- 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. RESULTS The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 +/- 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). CONCLUSIONS The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.ELSEVIER SCIENCE INC2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/3657JACC-Cardiovascular ImagingISSN: 1936878XISSNe: 18767591reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p36572026-06-07T16:35:31Z
dc.title.none.fl_str_mv Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
title Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
spellingShingle Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
Rodriguez-Palomares, Jose F
cardiac magnetic resonance
infarct size
left ventricular ejection fraction
left ventricular end-diastolic volume
left ventricular end-systolic volume
left ventricular remodeling
microvascular obstruction
prognosis
ST-segment elevation myocardial infarction
title_short Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
title_full Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
title_fullStr Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
title_full_unstemmed Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
title_sort Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.
dc.creator.none.fl_str_mv Rodriguez-Palomares, Jose F
Gavara, Jose
Ferreira-Gonzalez, Ignacio
Valente, Filipa
Rios, Cesar
Rodriguez-Garcia, Julian
Bonanad, Clara
Garcia Del Blanco, Bruno
Minana, Gema
Mutuberria, Maria
Nunez, Julio
Barrabes, Jose
Evangelista, Artur
Bodi, Vicente
Garcia-Dorado, David
author Rodriguez-Palomares, Jose F
author_facet Rodriguez-Palomares, Jose F
Gavara, Jose
Ferreira-Gonzalez, Ignacio
Valente, Filipa
Rios, Cesar
Rodriguez-Garcia, Julian
Bonanad, Clara
Garcia Del Blanco, Bruno
Minana, Gema
Mutuberria, Maria
Nunez, Julio
Barrabes, Jose
Evangelista, Artur
Bodi, Vicente
Garcia-Dorado, David
author_role author
author2 Gavara, Jose
Ferreira-Gonzalez, Ignacio
Valente, Filipa
Rios, Cesar
Rodriguez-Garcia, Julian
Bonanad, Clara
Garcia Del Blanco, Bruno
Minana, Gema
Mutuberria, Maria
Nunez, Julio
Barrabes, Jose
Evangelista, Artur
Bodi, Vicente
Garcia-Dorado, David
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv cardiac magnetic resonance
infarct size
left ventricular ejection fraction
left ventricular end-diastolic volume
left ventricular end-systolic volume
left ventricular remodeling
microvascular obstruction
prognosis
ST-segment elevation myocardial infarction
topic cardiac magnetic resonance
infarct size
left ventricular ejection fraction
left ventricular end-diastolic volume
left ventricular end-systolic volume
left ventricular remodeling
microvascular obstruction
prognosis
ST-segment elevation myocardial infarction
description OBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. METHODS Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 +/- 2.6 days) and after 6 months (6.1 +/- 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. RESULTS The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 +/- 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). CONCLUSIONS The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/3657
url https://incliva.portalinvestigacion.com/publicaciones/3657
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER SCIENCE INC
publisher.none.fl_str_mv ELSEVIER SCIENCE INC
dc.source.none.fl_str_mv JACC-Cardiovascular Imaging
ISSN: 1936878X
ISSNe: 18767591
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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