Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI
Rodriguez-Palomares, Jose F (Hospital Universitari Vall d'Hebron)
Gavara Doñate, Jose (Hospital Clínic Universitari (València))
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Valente, Filipa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rios, César (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodríguez-García, Julián (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bonanad, Clara (Hospital Clínic Universitari (València))
García del Blanco, Bruno (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Miñana, G. (Hospital Clínic Universitari (València))
Mutuberria Urdániz, María (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Nuñez, J. (Hospital Clínic Universitari (València))
Barrabés, José A.. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Evangelista Masip, Arturo (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bodi, Vicente (Hospital Clínic Universitari (València))
García-Dorado, David (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	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
Published in:	JACC: Cardiovascular Imaging, Vol. 12 Núm. 12 (december 2019) , p. 2445-2456, ISSN 1876-7591

DOI: 10.1016/j.jcmg.2019.02.025

12 p, 716.3 KB

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