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Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF
Bogdan-Flaviu Buz1,2,3, Sergiu-Florin Arnautu3,4, Mirela-Cleopatra Tomescu1,4
1Doctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Insights
Left ventricular reverse remodeling after ST-elevation myocardial infarction (STEMI) is linked to better outcomes. Men show more favorable remodeling than women, with global work efficiency predicting recovery.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Science
Background:
- Sex-specific differences in left ventricular (LV) reverse remodeling post-ST-segment elevation myocardial infarction (STEMI) are not well understood.
- Investigating predictors and outcomes of LV reverse remodeling, considering sex differences, is crucial for patient care.
Purpose of the Study:
- To explore predictors of LV reverse remodeling after STEMI.
- To examine the association between LV reverse remodeling and clinical outcomes, focusing on sex-specific variations.
- To identify factors influencing myocardial recovery in STEMI patients.
Main Methods:
- Echocardiographic parameters were assessed at baseline and six months in 253 STEMI patients (28% women).
- LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV).
- Multivariate logistic regression, Kaplan-Meier, and Cox regression analyses were used to identify predictors and evaluate clinical outcomes (MACEs).
Main Results:
- Reverse remodeling occurred in 43% of patients, being more frequent in men (47%) than women (37%).
- Independent predictors of remodeling included male sex and baseline global work efficiency (GWE).
- Patients with reverse remodeling had significantly lower major adverse cardiac events (MACEs) rates (10% vs. 24%).
Conclusions:
- LV reverse remodeling post-STEMI is associated with improved clinical outcomes and shows significant sex-specific differences.
- Baseline myocardial work indices, especially GWE, are strong predictors of reverse remodeling.
- Men exhibited a more favorable remodeling profile and myocardial recovery compared to women after STEMI.
Abstract:
Background: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. Methods: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14-22 months), including major adverse cardiac events (MACEs). Kaplan-Meier and Cox regression analyses were performed. Results: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, p = 0.04). Male sex (OR 0.30; 95% CI: 0.14-0.65; p < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45-1.85; p < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, p < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181-0.557; p < 0.0001). Conclusions: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women.
