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Published on: January 28, 2020
Prognostic value of reverse left ventricular remodeling after primary angioplasty for STEMI
Nazario Carrabba1, Guido Parodi, Renato Valenti
1Department of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
Insights
Reverse left ventricular remodeling occurred in nearly half of ST-elevation myocardial infarction patients after primary PCI. This remodeling is a key predictor of reduced long-term heart failure risk.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Prognostic value of reverse left ventricular (LV) remodeling post-STEMI is under-evaluated.
- Assessing reverse LV remodeling after primary percutaneous coronary intervention (P-PCI) is crucial.
Purpose of the Study:
- Investigate incidence of reverse LV remodeling in STEMI patients treated with P-PCI.
- Identify determinants of reverse LV remodeling.
- Evaluate long-term clinical significance of reverse LV remodeling.
Main Methods:
- 512 STEMI patients undergoing P-PCI had serial 2D-echocardiograms (baseline, 1 & 6 months).
- Reverse remodeling defined as >10% reduction in LV end-systolic volume at 6 months.
- Long-term follow-up assessed heart failure rates and survival.
Main Results:
- Reverse LV remodeling observed in 49% of patients.
- Lower heart failure rates (11% vs. 32%) in patients with reverse remodeling.
- Predictors included smaller infarct size (peak CK), less functional damage (WMSI), and baseline LVESV.
Conclusions:
- Reverse LV remodeling is common in successfully reperfused STEMI patients.
- Small infarct size and preserved LV function predict reverse remodeling.
- Reverse remodeling independently predicts favorable long-term heart failure-free survival.
Aims:
Thus far, the prognostic value of reverse left ventricular (LV) remodeling after ST-elevation acute myocardial infarction (STEMI) has not been fully evaluated. We sought to investigate the incidence, major determinants, and long-term clinical significance of reverse LV remodeling in a large series of STEMI patients successfully treated with primary percutaneous coronary intervention (P-PCI).
Methods And Results:
Serial complete 2D-echocardiograms were obtained within 24h after P-PCI, and at 1 and 6 months in 512 consecutive reperfused STEMI patients. Reverse remodeling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 month follow-up. Reverse LV remodeling occurred in 49% of study population. At follow-up (41.6±23 months), late heart failure (HF) rate was significantly higher among patients without reverse LV remodeling as compared with those with it (32% vs. 11%, P<0.0001). At multivariate analysis, independent predictors of reverse LV remodeling were a small infarct size measured as peak creatine kinase value (P<0.0001), a small functional myocardial damage measured as wall motion score index within the infarct zone (P=0.018) and baseline LVESV (P<0.0001). After adjustment for several clinical, echographic and angiographic variables, Cox analysis identified reverse LV remodeling as the only beneficial independent predictor of long-term heart failure-free survival (HR: 0.44, 95% CI: 0.275-0.722).
Conclusions:
Reverse LV remodeling occurred in half of successfully reperfused STEMI patients. Small structural and functional myocardial damages within the infarct zone are the major determinants of reverse LV remodeling. As expression of effective myocardial salvage by P-PCI, the reverse remodeling is an important predictor of favorable long-term outcome.
