Prognostic Value of Initial Left Ventricular Remodeling in Patients With 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 increa...

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Detalles Bibliográficos
Autores: Rodríguez Palomares, José F.|||0000-0002-7229-9780, Gavara Doñate, Jose|||0000-0002-3483-7066, Ferreira-Gonzalez, Ignacio|||0000-0002-1208-5561, Valente, Filipa|||0000-0002-5569-3292, Rios, César, Rodríguez-García, Julián, Bonanad, Clara, García del Blanco, Bruno|||0000-0002-4527-1600, Miñana, G., Mutuberria Urdániz, María, Nuñez, J., Barrabés, José A.|||0000-0001-7062-6277, Evangelista Masip, Arturo|||0000-0001-8182-1174, Bodi, Vicente|||0000-0001-6425-5828, García-Dorado, David|||0000-0002-1126-1279
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:223864
Acceso en línea:https://ddd.uab.cat/record/223864
https://dx.doi.org/urn:doi:10.1016/j.jcmg.2019.02.025
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
Descripción
Sumario: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.

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