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  3. Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.

Prognostic Value of Initial LeftVentricular Remodeling in PatientsWith Reperfused STEMI.

Fecha de publicación: Fecha Ahead of Print:

Autores de INCLIVA

Participantes ajenos a INCLIVA

  • Rodriguez-Palomares, Jose F
  • Ferreira-Gonzalez, Ignacio
  • Valente, Filipa
  • Rodriguez-Garcia, Julian
  • Garcia Del Blanco, Bruno
  • Mutuberria, Maria
  • Barrabes, Jose
  • Evangelista, Artur
  • Garcia-Dorado, David

Grupos y Plataformas de I+D+i

Abstract

OBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). BACKGROUND LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. METHODS Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 +/- 2.6 days) and after 6 months (6.1 +/- 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. RESULTS The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 +/- 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). CONCLUSIONS The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

© 2019 the authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND LICENSE (http://creativecommons.o rg/licenses/by-nc-nd/4.0/ )

Datos de la publicación

ISSN/ISSNe:
1936-878X, 1876-7591

JACC-CARDIOVASCULAR IMAGING  ELSEVIER SCIENCE INC

Tipo:
Article
Páginas:
2445-2456
PubMed:
31202752

Citas Recibidas en Web of Science: 75

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Keywords

  • cardiac magnetic resonance; infarct size; left ventricular ejection fraction; left ventricular end-diastolic volume; left ventricular end-systolic volume; left ventricular remodeling; microvascular obstruction; prognosis; ST-segment elevation myocardial infarction

Financiación

INSTITUTO SALUD CARLOS III (CB16/11/00486)
INSTITUTO SALUD CARLOS III (PI17/01836)
INSTITUTO SALUD CARLOS III (PIE15/00013)

Proyectos y Estudios Clínicos

A multidisciplinary project to advance in basic mechanisms, diagnosis, prediction, and prevention of cardiac damage in reperfused acute myocardial infarction.

Investigador Principal: VICENT BODÍ PERIS

PIE15/00013 . INSTITUTO SALUD CARLOS III . 2016

INCORPORACIÓN DE NUEVAS ÁREAS TEMÁTICAS Y NUEVOS GRUPOS AL CONSORCIO CIBER

Investigador Principal: VICENT BODÍ PERIS

CB16/11/00486 . INSTITUTO SALUD CARLOS III

Estudio multidisciplinar de la obstrucción microvascular y su reparación tras un infarto agudo de miocardio: de la arteria coronaria a la microcirculación. Foco en el factor VEGF-A165b (PI17/01836).

Investigador Principal: VICENT BODÍ PERIS

PI17/01836 . INSTITUTO SALUD CARLOS III . 2018

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