Redefining adverse and reverse left ventricular remodeling by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction and their implications on long-term prognosis

Heerajnarain Bulluck, Jaclyn Carberry, David Carrick, Margaret McEntegart, Mark C. Petrie, Hany Eteiba, Stuart Hood, Stuart Watkins, Mitchell Lindsay, Ahmed Mahrous, Ian Ford, Keith G. Oldroyd, Colin Berry

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Background: Cut off values for change in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) by cardiovascular magnetic resonance following ST-segment-elevation myocardial infarction have recently been proposed and 4 patterns of LV remodeling were described. We aimed to assess their long-term prognostic significance. Methods: A prospective cohort of unselected patients with ST-segment-elevation myocardial infarction with paired acute and 6-month cardiovascular magnetic resonance, with the 5-year composite end point of all-cause death and hospitalization for heart failure was included. The prognosis of the following groups (group 1: reverse LV remodeling [≥12% decrease in LVESV]; group 2: no LV remodeling [changes in LVEDV and LVESV <12%]; group 3: adverse LV remodeling with compensation [≥12% increase in LVEDV only]; and group 4: adverse LV remodeling [≥12% increase in both LVESV and LVEDV]) was compared. Results: Two hundred eighty-five patients were included with a median follow-up was 5.8 years. The composite end point occurred in 9.5% in group 1, 12.3% in group 2, 7.1% in group 3, and 24.2% in group 4. Group 4 had significantly higher cumulative event rates of the composite end point (log-rank test, P=0.03) with the other 3 groups showing similar cumulative event rates (log-rank test, P=0.51). Cox proportional hazard for group 2 (hazard ratio, 1.3 [95% CI, 0.6-3.1], P=0.53) and group 3 (hazard ratio, 0.6 [95% CI, 0.2-2.3], P=0.49) were not significantly different but was significantly higher in group 4 (hazard ratio, 3.0 [95% CI, 1.2-7.1], P=0.015) when compared with group 1. Conclusions: Patients with ST-segment-elevation myocardial infarction developing adverse LV remodeling at 6 months, defined as ≥12% increase in both LVESV and LVEDV by cardiovascular magnetic resonance, was associated with worse long-term clinical outcomes than those with adverse LV remodeling with compensation, reverse LV remodeling, and no LV remodeling, with the latter 3 groups having similar outcomes in a cohort of stable reperfused patients with ST-segment-elevation myocardial infarction. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.

    Original languageEnglish
    Article numbere009937
    JournalCirculation: Cardiovascular Imaging
    Volume13
    Issue number7
    Early online date21 Jul 2020
    DOIs
    Publication statusPublished - Jul 2020

    Keywords

    • Aged
    • Female
    • Humans
    • Magnetic Resonance Imaging
    • Male
    • Middle Aged
    • Percutaneous Coronary Intervention
    • Predictive Value of Tests
    • Prospective Studies
    • Recovery of Function
    • Risk Assessment
    • Risk Factors
    • ST Elevation Myocardial Infarction/diagnostic imaging
    • Stroke Volume
    • Time Factors
    • Treatment Outcome
    • Ventricular Function, Left
    • Ventricular Remodeling
    • heart failure
    • magnetic resonance imaging
    • ventricular remodeling
    • prognosis
    • percutaneous coronary intervention

    Cite this