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Redefining Adverse and Reverse Left Ventricular Remodeling by Cardiovascular Magnetic Resonance Following
Heerajnarain Bulluck1,2, Jaclyn Carberry3, David Carrick1,3
1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (H.B., D.C., M.M., M.C.P., H.E., S.H., S.W., M.L., A.M., K.G.O., C.B.).
Insights
Adverse left ventricular remodeling after myocardial infarction, specifically a ≥12% increase in both LVESV and LVEDV, predicts worse long-term outcomes. This pattern of adverse remodeling is linked to significantly higher rates of death and heart failure hospitalization.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Recent studies proposed cut-off values for changes in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) post-myocardial infarction.
- Four distinct patterns of left ventricular (LV) remodeling were identified using cardiovascular magnetic resonance (CMR).
Purpose of the Study:
- To evaluate the long-term prognostic significance of these identified patterns of LV remodeling.
- To determine if specific LV remodeling patterns after ST-segment-elevation myocardial infarction (STEMI) correlate with clinical outcomes.
Main Methods:
- A prospective cohort study included unselected STEMI patients.
- Paired CMR scans were obtained at acute phase and 6 months post-STEMI.
- The 5-year composite endpoint included all-cause death and heart failure hospitalization.
Main Results:
- A total of 285 patients were followed for a median of 5.8 years.
- Group 4 (adverse LV remodeling: ≥12% increase in both LVESV and LVEDV) showed significantly higher cumulative event rates (24.2%) compared to other groups.
- Cox proportional hazard analysis revealed a significantly higher risk of adverse events in Group 4 (HR 3.0, P=0.015) compared to Group 1 (reverse remodeling).
Conclusions:
- Adverse LV remodeling, defined as a ≥12% increase in both LVESV and LVEDV by CMR at 6 months, is associated with worse long-term clinical outcomes in STEMI patients.
- The identified patterns of LV remodeling provide prognostic information for patients post-STEMI.
- Reverse remodeling, no remodeling, and adverse remodeling with compensation showed similar long-term outcomes, distinct from severe adverse remodeling.
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.
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