Left Ventricular Post-Infarct Remodeling: Implications for Systolic Function Improvement and Outcomes in the Modern
Pieter van der Bijl1, Rachid Abou1, Laurien Goedemans1
1Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
Insights
Left ventricular remodeling after heart attacks is common with modern treatments. While it doesn't affect long-term survival, it significantly increases heart failure hospitalizations, necessitating improved preventative strategies.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Left ventricular (LV) remodeling post-ST-segment elevation myocardial infarction (STEMI) is linked to adverse outcomes.
- Previous studies on LV remodeling prognoses were conducted before current primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy standards.
- Re-evaluation of LV remodeling's long-term impact in the contemporary STEMI treatment era is crucial.
Purpose of the Study:
- To investigate the impact of post-infarct left ventricular (LV) remodeling on patient outcomes in the current era of STEMI management.
- To assess the prognostic significance of LV remodeling following primary PCI for STEMI.
Main Methods:
- Analysis of echocardiograms from 1,995 STEMI patients treated with primary PCI at baseline and up to 12 months.
- LV remodeling defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct.
- Outcomes, including mortality and heart failure hospitalization, were analyzed over a median follow-up of 94 months.
Main Results:
- Nearly half (48%) of STEMI patients exhibited LV remodeling within 12 months.
- No significant difference in long-term survival was observed between patients with and without LV remodeling (p=0.144).
- LV remodelers had a significantly higher likelihood of hospitalization for heart failure compared to non-remodelers (p<0.001).
Conclusions:
- Post-STEMI LV remodeling is prevalent even with contemporary primary PCI and pharmacotherapy.
- LV remodeling does not impact long-term mortality but is associated with increased heart failure hospitalizations.
- Intensified preventative strategies are needed for STEMI patients who develop LV remodeling.
Objectives:
This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era.
Background:
LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombolysis, whereas the long-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.
Methods:
Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed.
Results:
A total of 1,995 patients with STEMI were studied (mean age 60 ± 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartile range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001).
Conclusions:
In the contemporary era, in which STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients.
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