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Updated: May 30, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
[Predictive model for ejection fraction improvement at one year in patients with acute ST-segment elevation
1Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200127, China.
Insights
A predictive model identifies factors like smaller infarct size and lower BNP levels that improve ejection fraction in heart failure patients post-STEMI. This model aids in predicting recovery for heart failure with improved ejection fraction (HFimpEF).
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Context:
- Heart failure with reduced ejection fraction (HFrEF) following acute ST-segment elevation myocardial infarction (STEMI) presents a significant clinical challenge.
- Left ventricular ejection fraction (LVEF) improvement is a key indicator of recovery and improved prognosis.
- Identifying patients likely to improve is crucial for tailored management strategies.
Purpose:
- To develop and validate a predictive model for LVEF improvement one year after STEMI in patients with HFrEF.
- To identify clinical and imaging predictors of LVEF recovery in this population.
Summary:
- A nested case-control study of 117 STEMI patients with HFrEF developed a predictive model for LVEF improvement.
- Key predictors identified include smaller baseline left ventricular end-systolic diameter (LVESD), smaller infarct size, lower peak B-type natriuretic peptide (BNP) and soluble suppression of tumorigenicity 2 (sST2) levels, and higher hematocrit.
- The model demonstrated good predictive ability (AUC=0.805) and clinical utility.
Impact:
- The developed model can assist clinicians in identifying STEMI patients with HFrEF who are likely to achieve improved ejection fraction.
- This facilitates personalized treatment approaches and resource allocation.
- The findings contribute to a better understanding of the mechanisms underlying LVEF recovery post-STEMI.
Abstract:
Objective: To develop a predictive model for improvement of ejection fraction 1 year after heart failure with reduced ejection fraction (HFrEF) following acute ST-segment elevation myocardial infarction (STEMI). Methods: This nested case-control study included STEMI patients diagnosed with HFrEF from a prospective multicenter multimodality imaging cohort between August 2014 and March 2021. Based on the improvement of left ventricular ejection fraction (LVEF) at baseline and 1-year follow-up, the patients were classified into the heart failure with improved ejection fraction (HFimpEF) group and the persistent HFrEF group. The clinical data were collected, and cardiac histological changes were assessed using cardiac magnetic resonance imaging. Multivariate logistic regression analysis was performed to identify factors associated with ejection fraction improvement at one year, and a predictive model was developed and internally validated. The performance and clinical applicability of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Results: A total of 117 STEMI patients (102 males and 15 females) aged (61.6±11.6) years were included in the study. At the 1-year follow-up, there were 61 patients (52.1%)in the HFimpEF group,and 56 patients (47.9%) in the HFrEF group . Compared with persistent HFrEF group, patients in HFimpEF group had smaller baseline left ventricular end-systolic diameter (LVESD) [33.0 (30.0, 36.0) mm vs 35.5 (32.0, 39.0) mm], smaller infarct size [26.1% (20.3%, 36.0)% vs 40.6% (33.0%, 45.4)%], lower peak B-type natriuretic peptide (BNP) level [340.0 (190.5, 692.5) ng/L vs 636.0 (318.5, 1 188.8) ng/L], lower peak level of soluble suppression of tumorigenicity 2 (sST2) [36.7 (25.8, 60.5) μg/L vs 62.4 (30.6, 120.7) μg/L], and higher hematocrit [(43.5%±3.5%) vs (40.8%±5.6%)] (all P<0.05). Multivariate logistic regression analysis revealed that smaller baseline LVESD (OR=0.825, 95%CI: 0.745-0.914), smaller infarct size (OR=0.967, 95%CI: 0.939-0.995), peak BNP level≤400 ng/L (OR=3.062, 95%CI: 1.283-7.306), peak sST2 level≤35 μg/L (OR=2.600, 95%CI: 1.040-6.501), and higher hematocrit (OR=1.109, 95%CI: 1.030-1.193) were predictors of LVEF improvement in STEMI patients with HFrEF. The predictive model formula: logit (P)=2.619-0.034×infarcted myocardium percentage (%)+1.119×(peak BNP level≤400 ng/L)+0.956×(peak sST2 level≤35 μg/L)+0.103×hematocrit (%)-0.192×LVESC (mm) (where peak BNP level≤400 ng/L and peak sST2 level≤35 μg/L are binary variables: Yes=1, No=0). The area under the ROC curve (AUC) was 0.805 (95%CI: 0.723-0.887), indicating good predictive ability. Calibration curves and decision curve analysis indicated good model consistency and clinical utility. Conclusions: Smaller LVESD, smaller infarct size, peak BNP level≤400 ng/L, peak sST2 level≤35 μg/L and higher hematocrit are predictive factors for LVEF improvement after STEMI. The predictive model has good performance for predicting HFimpEF.
