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Association of aortic stiffness early post myocardial infarction with left ventricular remodelling

George Pavlidis1, Damianos Tsilivarakis1, Konstantinos Katogiannis1

  • 12nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

European Journal of Clinical Investigation
|September 7, 2023
PubMed

Insights

Aortic stiffness measured early after myocardial infarction predicts long-term left ventricular (LV) remodelling. Lower aortic stiffness and better LV global longitudinal strain (GLS) are associated with reverse LV remodelling, indicating improved heart function post-infarction.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Echocardiography

Background:

  • Adverse left ventricular (LV) remodelling post-myocardial infarction (MI) is a significant predictor of heart failure.
  • Assessing aortic stiffness early after acute ST-segment elevation myocardial infarction (STEMI) may offer insights into long-term LV remodelling.
  • Understanding this relationship is crucial for developing targeted interventions to improve patient outcomes after MI.

Purpose of the Study:

  • To investigate the association between aortic stiffness in acute STEMI and LV remodelling at 2-year follow-up.
  • To evaluate the predictive value of baseline aortic stiffness and LV mechanics for reverse LV remodelling.
  • To explore the ventricular-arterial interaction using the PWV/GLS ratio.

Main Methods:

  • Carotid-femoral pulse wave velocity (PWV) and LV global longitudinal strain (GLS) were measured in 109 patients within 48 hours of MI and at 2-year follow-up.
  • LV volumes and left atrial strain were assessed using speckle-tracking echocardiography.
  • The PWV/GLS ratio was calculated as a marker of ventricular-arterial interaction.

Main Results:

  • After 2 years, patients showed reduced PWV and improved GLS and reservoir left atrial strain (p < .05).
  • Baseline PWV, GLS, PWV/GLS ratio, and reservoir left atrial strain were significantly associated with changes in LV end-systolic volume.
  • Lower baseline PWV, less impaired GLS, and a lower PWV/GLS ratio independently predicted reverse LV remodelling at 2 years (C-statistics: .748, .711, .787, respectively).

Conclusions:

  • Aortic stiffness measured early after myocardial infarction is a key determinant of long-term LV remodelling.
  • Successful revascularization does not negate the impact of early aortic stiffness on LV remodelling.
  • These findings highlight the importance of assessing aortic stiffness in the acute phase post-MI to predict long-term cardiac outcomes.
Abstract

Keywords:
aortic stiffnessglobal longitudinal strainleft ventricular remodellingmyocardial infarctionpulse wave velocityspeckle-tracking echocardiography

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