Force Reversal During Systolic-Diastolic Transition Provides Incremental Prognostic Value over LVEF for Heart Failure
Yumeng Sun1, Xinyu Wu1, Lu Li1
1Department of Radiology, Anzhen Hospital, Affiliated to Capital Medical University, 2 Anzhen Road, Chao Yang District, Beijing 100029, China.
Insights
Anterior myocardial infarction impairs left ventricular hemodynamic forces (LV HDFs) and causes force reversal, predicting heart failure (HF). Larger infarct size also alters LV HDFs, impacting HF risk in ST-elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Left ventricular hemodynamic forces (LV HDFs) are crucial in myocardial function but are altered in dysfunction.
- The impact of infarct location and size on LV HDFs post-ST-elevation myocardial infarction (STEMI) requires clarification.
- Understanding these effects is vital for predicting heart failure (HF) development.
Purpose of the Study:
- To investigate how infarct location and size affect LV HDFs in STEMI patients.
- To assess the prognostic value of LV HDFs, specifically force reversal, for predicting new-onset HF.
- To determine if LV HDFs offer incremental prognostic value beyond ejection fraction.
Main Methods:
- Retrospective analysis of 275 STEMI patients using cardiac magnetic resonance (CMR) imaging.
- Derivation of LV HDFs (apical-basal, lateral-septal forces, force direction angle, force reversal) from cine images.
- Stratification by infarct location (anterior vs. non-anterior) and infarct size; primary endpoint: new-onset HF.
Main Results:
- Anterior STEMI demonstrated significantly impaired LV HDFs and was linked to force reversal (OR 2.31).
- Larger infarct size correlated with reduced apical-basal forces and altered force distribution (increased L-S/A-B ratio, decreased φ).
- Force reversal independently predicted HF (HR 2.10) and improved prediction accuracy over LVEF alone (C-statistic 0.770 vs. 0.680).
Conclusions:
- Anterior infarction leads to global LV HDF impairment and force reversal.
- Larger infarct size primarily affects longitudinal forces and force distribution.
- Force reversal is a significant predictor of HF post-STEMI, offering added prognostic value to LVEF.
Abstract:
Background: Left ventricular hemodynamic forces (LV HDFs) are altered in myocardial dysfunction. While infarct location and size influence post-ST-segment elevation myocardial infarction (STEMI) remodeling, their specific effects on HDFs remain unclear. This study investigated how infarct location and size impact left ventricular HDFs and assessed HDFs' prognostic value for predicting subsequent heart failure (HF) in STEMI patients. Methods: In this retrospective study, 275 STEMI patients underwent cardiac magnetic resonance (CMR) 3-7 days after primary percutaneous coronary intervention. HDFs were derived from routine CMR cine images. Patients were stratified by infarct location (anterior vs. non-anterior) and median infarct size (IS). Key parameters-apical-basal (A-B) and lateral-septal (L-S) forces, their ratio, force direction angle (φ), and force reversal during systolic-diastolic transition-were compared. The primary endpoint was new-onset congestive HF during follow-up. Results: Compared to non-anterior STEMI, anterior STEMI showed significantly impaired A-B and L-S HDFs throughout the cardiac cycle (all p < 0.05) and was independently associated with force reversal (OR 2.31, 95% CI: 1.05-5.07). Larger IS correlated with reduced A-B HDFs and altered force distribution (increased L-S/A-B ratio, decreased φ). Force reversal predicted HF (HR: 2.10, 95% CI: 1.22-3.62) and provided incremental prognostic value beyond left ventricular ejection fraction (LVEF) alone (C-statistic: LVEF 0.680 vs. LVEF + force reversal 0.770, p = 0.034). Conclusions: Anterior infarction causes global HDF impairment and force reversal, while larger IS primarily reduces longitudinal forces and disrupts force distribution. Force reversal predicts subsequent HF and enhances prognostic value beyond LVEF.
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