Author + information
- Received October 8, 2018
- Revision received January 17, 2019
- Accepted February 22, 2019
- Published online December 2, 2019.
- Jose F. Rodriguez-Palomares, MD, PhDa,b,∗,
- Jose Gavara, MScc,∗,
- Ignacio Ferreira-González, MD, PhDa,d,
- Filipa Valente, MDa,b,
- César Rios, MScc,
- Julián Rodríguez-García, MDa,b,
- Clara Bonanad, MD, PhDc,
- Bruno García del Blanco, MD, PhDa,b,
- Gema Miñana, MD, PhDc,
- Maria Mutuberria, MDa,b,
- Julio Nuñez, MD, PhDc,
- José Barrabés, MD, PhDa,b,
- Artur Evangelista, MD, PhDa,b,
- Vicente Bodí, MD, PhDc,∗∗ ( and )
- David García-Dorado, MD, PhDa,b,∗ ()
- aDepartment of Cardiology, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- bCentro de Investigación Biomédica en Red-para enfermedades cardiovasculares, CIBERCV, Madrid, Spain
- cDepartment of Cardiology, Hospital Clinico Universitario, CIBERCV, INCLIVA, University of Valencia, Valencia, Spain
- dCIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- ↵∗Address for correspondence:
Dr. David García-Dorado, Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR) Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain.
- ↵∗∗Dr. Vicente Bodi, Department of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Blasco Ibañez 17, 46010 Valencia, Spain.
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.
- cardiac magnetic resonance
- infarct size
- left ventricular ejection fraction
- left ventricular end-diastolic volume
- left ventricular end-systolic volume
- left ventricular remodeling
- microvascular obstruction
- ST-segment elevation myocardial infarction
↵∗ Drs. Rodriguez-Palomares and Gavara contributed equally to this study.
This work was funded by the Instituto de Salud Carlos III and co-funded by the European Regional Development Fund grants EC07/90511, PI17/01836, PIE15/00013, CIBERCV16/11/00486, and CIBERCV16/11/00479. Dr. Ferreira-González served on advisory boards for Bayer, Bristol-Myers Squibb, and Sanofi; and received grants from the Spanish Health Ministry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 8, 2018.
- Revision received January 17, 2019.
- Accepted February 22, 2019.
- 2019 The Authors