Predictive value of early left ventricular end-diastolic volume changes for late left ventricular remodeling after
Lei Yi1, Tianqi Zhu1, Xuezheng Qu1
1Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Early changes in left ventricular end-diastolic volume (LVEDV) after myocardial infarction predict later remodeling. Monitoring LVEDV at discharge and 1 month post-PCI can help identify patients at risk for left ventricular remodeling.
Area of Science:
- Cardiology
- Cardiac Imaging
- Interventional Cardiology
Background:
- Left ventricular remodeling (LVR) is a key predictor of adverse outcomes following acute ST-elevation myocardial infarction (STEMI).
- Primary percutaneous coronary intervention (PCI) is a standard treatment for STEMI.
- Understanding early indicators of LVR is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate LVR in STEMI patients treated with primary PCI.
- To examine the relationship between early left ventricular dilation and late LVR.
- To identify early echocardiographic markers that predict LVR.
Main Methods:
- 301 consecutive STEMI patients undergoing primary PCI were enrolled.
- Serial echocardiography was performed at multiple time points: day 1 post-PCI, discharge, 1 month, and 6 months.
- Changes in left ventricular end-diastolic volume (LVEDV) were analyzed.
Main Results:
- Left ventricular remodeling (LVR) occurred in 18.9% of patients.
- LVEDV decreased from day 1 to discharge in the LVR group, contrasting with the non-LVR group.
- Early changes in LVEDV at discharge and 1 month post-PCI accurately predicted late LVR (AUC = 0.80).
Conclusions:
- Both decreased LVEDV at discharge and increased LVEDV at 1-month follow-up are associated with late LVR at 6 months.
- Early and comprehensive monitoring of LVEDV changes is vital for predicting LVR.
- These findings support the use of serial echocardiography for risk stratification in STEMI patients.
Backgroud:
Left ventricular remodeling (LVR) is a major predictor of adverse outcomes in patients with acute ST-elevation myocardial infarction (STEMI). This study aimed to prospectively evaluate LVR in patients with STEMI who were successfully treated with primary percutaneous coronary intervention (PCI) and examine the relationship between early left ventricular dilation and late LVR.
Methods:
Overall 301 consecutive patients with STEMI who underwent primary PCI were included. Serial echocardiography was performed on the first day after PCI, on the day of discharge, at 1 month, and 6 months after discharge.
Results:
Left ventricular remodeling occurred in 57 (18.9%) patients during follow-up. Left ventricular end-diastolic volume (LVEDV) reduced from day 1 postoperative to discharge in the LVR group compared with that in the non-LVR (n-LVR) group. The rates of change in LVEDV (ΔLVEDV%) were -5.24 ± 16.02% and 5.05 ± 16.92%, respectively (p < 0.001). LVEDV increased in patients with LVR compared with n-LVR at 1-month and 6-month follow-ups (ΔLVEDV% 13.05 ± 14.89% vs. -1.9 ± 12.03%; 26.46 ± 14.05% vs. -3.42 ± 10.77%, p < 0.001). Receiver operating characteristic analysis showed that early changes in LVEDV, including ΔLVEDV% at discharge and 1-month postoperative, predicted late LVR with an area under the curve value of 0.80 (95% confidence interval 0.74-0.87, p < 0.0001).
Conclusions:
Decreased LVEDV at discharge and increased LVEDV at 1-month follow-up were both associated with late LVR at 6-month. Comprehensive and early monitoring of LVEDV changes may help to predict LVR.
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