1. Redefining Adverse and Reverse Left Ventricular Remodeling by Cardiovascular Magnetic Resonance Following ST-Segment–Elevation Myocardial Infarction and Their Implications on Long-Term Prognosis
- Author
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David Carrick, Stuart Watkins, Margaret McEntegart, Colin Berry, Mark C. Petrie, Jaclyn Carberry, Mitchell Lindsay, Ian Ford, Heerajnarain Bulluck, Hany Eteiba, Stuart Hood, Keith G. Oldroyd, and Ahmed Mahrous
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Risk Assessment ,Ventricular Function, Left ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,ST segment ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Myocardial infarction ,Ventricular remodeling ,Aged ,Ventricular Remodeling ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Stroke Volume ,Magnetic resonance imaging ,Recovery of Function ,Stroke volume ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Predictive value of tests ,Heart failure ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business - 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 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.
- Published
- 2020
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