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Functional classification of left ventricular remodelling: prognostic relevance in myocardial infarction

Surenjav Chimed1, Pieter van der Bijl1, Rodolfo Lustosa1

  • 1Department of Cardiology, Heart and Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.

ESC Heart Failure
|January 22, 2022
PubMed

Insights

This study reclassified left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) by including LV function. Patients with LV remodelling and impaired ejection fraction (EF) had significantly worse outcomes, improving risk stratification.

Area of Science:

  • Cardiology
  • Clinical Research
  • Medical Diagnostics

Background:

  • Current post-ST-segment elevation myocardial infarction (STEMI) left ventricular (LV) remodelling definitions focus solely on structural changes (dilatation).
  • LV function, specifically ejection fraction (EF), is a known predictor of long-term outcomes post-STEMI.
  • Integrating functional parameters into remodelling classification may enhance prognostic accuracy.

Purpose of the Study:

  • To reclassify LV remodelling after STEMI by incorporating both LV dilatation and LVEF.
  • To investigate the prognostic implications of this integrated functional LV remodelling classification.
  • To assess if functional remodelling improves risk stratification beyond structural changes alone.

Main Methods:

  • Retrospective analysis of STEMI patients treated with primary percutaneous coronary intervention (PCI).
  • Patients were categorized into four subgroups based on LV dilatation and LVEF impairment.
  • Outcomes including mortality and heart failure hospitalization were analyzed over a median follow-up of 76 months.

Main Results:

  • A total of 2346 patients were studied.
  • Patients with both LV remodelling and impaired LVEF exhibited significantly lower survival rates (P < 0.001).
  • Event-free survival rates were also significantly lower in the group with LV dilatation and LVEF impairment (P < 0.001).

Conclusions:

  • A functional LV remodelling classification improves risk stratification compared to structural remodelling alone.
  • Identifying patients with the worst prognosis through functional assessment enables early preventative therapies.
  • This approach offers a more comprehensive understanding of post-STEMI cardiac changes and patient outcomes.
Abstract

Keywords:
HF hospitalizationSTEMImortalityprognosisremodelling

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