Integrated left ventricular geometry-function phenotypes and long-term outcomes after acute myocardial infarction

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.