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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Integrated left ventricular geometry-function phenotypes and long-term outcomes after acute myocardial infarction
Seonmin Park1, Seok Oh2, Yongwhan Lim2
1Department of Cardiology, Presbyterian Medical Center, Jeonju, Republic of Korea.
Insights
Left ventricular dilatation after acute myocardial infarction (AMI) poses a higher risk only when systolic function is reduced. Integrated assessment of left ventricular geometry and function improves risk stratification beyond ejection fraction alone.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Left ventricular (LV) remodeling post-acute myocardial infarction (AMI) significantly impacts long-term patient outcomes.
- The interplay between LV geometry and systolic function in predicting prognosis after AMI requires further investigation in diverse populations.
Purpose of the Study:
- To investigate the combined prognostic impact of LV dilatation and systolic dysfunction in patients following AMI.
- To determine if LV dilatation alone or in conjunction with reduced ejection fraction influences major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- Analysis of 19,664 patients with AMI from Korean nationwide multicenter registries.
- Phenotyping based on LV end-diastolic dimension (LVEDD) for dilatation and LV ejection fraction (LVEF) for systolic function.
- Utilized multivariable Cox proportional hazards models to assess the association between geometry-function phenotypes and 3-year MACCE.
Main Results:
- The incidence of MACCE increased progressively across phenotypes: non-dilated/preserved (13.2%), dilated/preserved (13.5%), non-dilated/reduced (16.8%), and dilated/reduced (21.9%).
- LV dilatation was not significantly associated with increased risk in patients with preserved LVEF.
- LV dilatation was associated with a significantly higher risk of MACCE when combined with reduced LVEF.
Conclusions:
- The prognostic significance of LV dilatation after AMI is contingent upon the underlying systolic function.
- LV dilatation in the context of reduced LVEF identifies a high-risk patient phenotype.
- Integrated assessment of LV geometry and function offers enhanced risk stratification beyond LVEF alone.
Background/Aims:
Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is a key determinant of long-term outcomes. However, it remains unclear how LV geometry and systolic function interact to influence prognosis in real-world populations. We investigated the combined prognostic impact of LV dilatation and systolic dysfunction in patients with AMI.
Methods:
We analyzed 19,664 patients with AMI from nationwide Korean multicenter registries. LV geometry-function phenotypes were defined according to LV end-diastolic dimension (LVEDD ≥53 mm for dilatation) and LV ejection fraction (LVEF ≤50% for reduced systolic function), and categorized as non-dilated/preserved (group A), dilated/preserved (group B), non-dilated/reduced (group C), and dilated/reduced (group D). The primary endpoint was 3-year major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, non-fatal myocardial infarction, unplanned revascularization, cerebrovascular accident, and cardiovascular readmission. Associations between baseline geometry-function phenotypes and outcomes were assessed using multivariable Cox proportional hazards models.
Results:
The incidence of MACCE increased stepwise from group A to D (13.2%, 13.5%, 16.8%, and 21.9%, respectively). In fully adjusted analyses, LV dilatation was not associated with increased risk in patients with preserved LVEF [group B vs. group A: hazard ratio (HR), 1.13; 95% confidence interval, 0.99-1.29]. In contrast, LV dilatation was associated with a higher risk when accompanied by reduced LVEF [group C: HR, 1.12 (1.01-1.24); group D: HR, 1.44 (1.29-1.60)].
Conclusions:
The prognostic significance of LV dilatation after AMI depends on underlying systolic function. While LV dilatation alone may reflect a compensatory process in preserved LVEF, its presence in reduced LVEF identifies a high-risk phenotype. An integrated assessment of LV geometry and function may provide complementary risk stratification beyond conventional LVEF-based assessment.
