Redefining adverse and reverse left ventricular remodeling by cardiovascular magnetic resonance following ST-segment elevation myocardial infarction and their implications on long-term prognosis

Bulluck, H. et al. (2020) Redefining adverse and reverse left ventricular remodeling by cardiovascular magnetic resonance following ST-segment elevation myocardial infarction and their implications on long-term prognosis. Circulation: Cardiovascular Imaging, 13(7), e009937. (doi: 10.1161/CIRCIMAGING.119.009937) (PMID:32689822)

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Abstract

Background: Cut off values for change in left ventricular end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) by cardiovascular magnetic resonance following ST-segment–elevation myocardial infarction have recently been proposed and 4 patterns of LV remodeling were described. We aimed to assess their long-term prognostic significance. Methods: A prospective cohort of unselected patients with ST-segment–elevation myocardial infarction with paired acute and 6-month cardiovascular magnetic resonance, with the 5-year composite end point of all-cause death and hospitalization for heart failure was included. The prognosis of the following groups (group 1: reverse LV remodeling [≥12% decrease in LVESV]; group 2: no LV remodeling [changes in LVEDV and LVESV <12%]; group 3: adverse LV remodeling with compensation [≥12% increase in LVEDV only]; and group 4: adverse LV remodeling [≥12% increase in both LVESV and LVEDV]) was compared. Results: Two hundred eighty-five patients were included with a median follow-up was 5.8 years. The composite end point occurred in 9.5% in group 1, 12.3% in group 2, 7.1% in group 3, and 24.2% in group 4. Group 4 had significantly higher cumulative event rates of the composite end point (log-rank test, P=0.03) with the other 3 groups showing similar cumulative event rates (log-rank test, P=0.51). Cox proportional hazard for group 2 (hazard ratio, 1.3 [95% CI, 0.6–3.1], P=0.53) and group 3 (hazard ratio, 0.6 [95% CI, 0.2–2.3], P=0.49) were not significantly different but was significantly higher in group 4 (hazard ratio, 3.0 [95% CI, 1.2–7.1], P=0.015) when compared with group 1. Conclusions: Patients with ST-segment–elevation myocardial infarction developing adverse LV remodeling at 6 months, defined as ≥12% increase in both LVESV and LVEDV by cardiovascular magnetic resonance, was associated with worse long-term clinical outcomes than those with adverse LV remodeling with compensation, reverse LV remodeling, and no LV remodeling, with the latter 3 groups having similar outcomes in a cohort of stable reperfused patients with ST-segment–elevation myocardial infarction.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Mahrous Abouzaid, Dr Ahmed and McEntegart, Dr Margaret and Carrick, Dr David and Petrie, Professor Mark and Bulluck, Dr Heerajnarain and Eteiba, Dr Hany and Oldroyd, Dr Keith and Carberry, Miss Jaclyn and Ford, Professor Ian and Hood, Dr Stuart
Authors: Bulluck, H., Carberry, J., Carrick, D., McEntegart, M., Petrie, M. C., Eteiba, H., Hood, S., Watkins, S., Lindsay, M., Mahrous, A., Ford, I., Oldroyd, K. G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Imaging
Publisher:American Heart Association
ISSN:1941-9651
ISSN (Online):1942-0080
Copyright Holders:Copyright © 2020 American Heart Association, Inc
First Published:First published in Circulation: Cardiovascular Imaging 13(7):e009937
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
190350Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474Institute of Cardiovascular & Medical Sciences