Prognosis-based definition of left ventricular remodeling after ST-elevation myocardial infarction View Full Text


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Article Info

DATE

2018-12-13

AUTHORS

Martin Reindl, Sebastian Johannes Reinstadler, Christina Tiller, Hans-Josef Feistritzer, Markus Kofler, Alexandra Brix, Agnes Mayr, Gert Klug, Bernhard Metzler

ABSTRACT

ObjectivesCardiac magnetic resonance (CMR) is the gold-standard modality for the assessment of left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI) patients. However, the commonly used remodeling criteria have never been validated for hard clinical events. We therefore aimed to define clear CMR criteria of LV remodeling following STEMI with proven prognostic impact.MethodsThis observational study included 224 patients suffering from acute STEMI. CMR was performed within 1 week and 4 months after infarction to evaluate different remodeling criteria including relative changes in LV end-diastolic volume (%∆LVEDV), end-systolic volume (%∆LVESV), ejection fraction (%∆LVEF), and myocardial mass (%∆LVMM). Primary endpoint was the occurrence of major adverse cardiovascular events (MACE) including all-cause death, re-infarction, stroke, and new congestive heart failure 24 months following STEMI. Secondary endpoint was defined as composite of primary endpoint and cardiovascular hospitalization. The Mann–Whitney U test was applied to assess differences in LV remodeling measures between patients with and without MACE. Values for the prediction of primary and secondary endpoints were assessed by c-statistics and Cox regression analysis.ResultsThe incidence of MACE (n = 13, 6%) was associated with higher %∆LVEDV (p = 0.002) and %∆LVMM (p = 0.02), whereas %∆LVESV and %∆LVEF were not significantly related to MACE (p > 0.05). The area under the curve (AUC) for the prediction of MACE was 0.76 (95% confidence interval [CI], 0.65–0.87) for %∆LVEDV (optimal cut-off 10%) and 0.69 (95%CI, 0.52–0.85) for %∆LVMM (optimal cut-off 5%). From all remodeling criteria, %∆LVEDV ≥ 10% showed highest hazard ratio (8.68 [95%CI, 2.39–31.56]; p = 0.001) for MACE. Regarding secondary endpoint (n = 35, 16%), also %∆LVEDV with an optimal threshold of 10% emerged as strongest prognosticator (AUC 0.66; 95%CI, 0.56–0.75; p = 0.004).ConclusionsFollowing revascularized STEMI, %∆LVEDV ≥ 10% showed strongest association with clinical outcome, suggesting this criterion as preferred CMR-based definition of post-STEMI LV remodeling.Key Points• CMR-determined %∆LVEDV and %∆LVMM were significantly associated with MACE following STEMI.• Neither %∆LVESV nor %∆LVEF showed a significant relation to MACE.• %∆LVEDV ≥ 10 was revealed as LV remodeling definition with highest prognostic validity. More... »

PAGES

2330-2339

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00330-018-5875-3

DOI

http://dx.doi.org/10.1007/s00330-018-5875-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1110580126

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30547201


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    "description": "ObjectivesCardiac magnetic resonance (CMR) is the gold-standard modality for the assessment of left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI) patients. However, the commonly used remodeling criteria have never been validated for hard clinical events. We therefore aimed to define clear CMR criteria of LV remodeling following STEMI with proven prognostic impact.MethodsThis observational study included 224 patients suffering from acute STEMI. CMR was performed within 1\u00a0week and 4\u00a0months after infarction to evaluate different remodeling criteria including relative changes in LV end-diastolic volume (%\u2206LVEDV), end-systolic volume (%\u2206LVESV), ejection fraction (%\u2206LVEF), and myocardial mass (%\u2206LVMM). Primary endpoint was the occurrence of major adverse cardiovascular events (MACE) including all-cause death, re-infarction, stroke, and new congestive heart failure 24\u00a0months following STEMI. Secondary endpoint was defined as composite of primary endpoint and cardiovascular hospitalization. The Mann\u2013Whitney U test was applied to assess differences in LV remodeling measures between patients with and without MACE. Values for the prediction of primary and secondary endpoints were assessed by c-statistics and Cox regression analysis.ResultsThe incidence of MACE (n\u2009=\u200913, 6%) was associated with higher %\u2206LVEDV (p\u2009=\u20090.002) and %\u2206LVMM (p\u2009=\u20090.02), whereas %\u2206LVESV and %\u2206LVEF were not significantly related to MACE (p\u2009>\u20090.05). The area under the curve (AUC) for the prediction of MACE was 0.76 (95% confidence interval [CI], 0.65\u20130.87) for %\u2206LVEDV (optimal cut-off 10%) and 0.69 (95%CI, 0.52\u20130.85) for %\u2206LVMM (optimal cut-off 5%). From all remodeling criteria, %\u2206LVEDV \u2265\u200910% showed highest hazard ratio (8.68 [95%CI, 2.39\u201331.56]; p\u2009=\u20090.001) for MACE. Regarding secondary endpoint (n\u2009=\u200935, 16%), also %\u2206LVEDV with an optimal threshold of 10% emerged as strongest prognosticator (AUC 0.66; 95%CI, 0.56\u20130.75; p\u2009=\u20090.004).ConclusionsFollowing revascularized STEMI, %\u2206LVEDV \u2265\u200910% showed strongest association with clinical outcome, suggesting this criterion as preferred CMR-based definition of post-STEMI LV remodeling.Key Points\u2022 CMR-determined %\u2206LVEDV and %\u2206LVMM were significantly associated with MACE following STEMI.\u2022 Neither %\u2206LVESV nor %\u2206LVEF showed a significant relation to MACE.\u2022 %\u2206LVEDV \u2265\u200910 was revealed as LV remodeling definition with highest prognostic validity.", 
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29 schema:description ObjectivesCardiac magnetic resonance (CMR) is the gold-standard modality for the assessment of left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI) patients. However, the commonly used remodeling criteria have never been validated for hard clinical events. We therefore aimed to define clear CMR criteria of LV remodeling following STEMI with proven prognostic impact.MethodsThis observational study included 224 patients suffering from acute STEMI. CMR was performed within 1 week and 4 months after infarction to evaluate different remodeling criteria including relative changes in LV end-diastolic volume (%∆LVEDV), end-systolic volume (%∆LVESV), ejection fraction (%∆LVEF), and myocardial mass (%∆LVMM). Primary endpoint was the occurrence of major adverse cardiovascular events (MACE) including all-cause death, re-infarction, stroke, and new congestive heart failure 24 months following STEMI. Secondary endpoint was defined as composite of primary endpoint and cardiovascular hospitalization. The Mann–Whitney U test was applied to assess differences in LV remodeling measures between patients with and without MACE. Values for the prediction of primary and secondary endpoints were assessed by c-statistics and Cox regression analysis.ResultsThe incidence of MACE (n = 13, 6%) was associated with higher %∆LVEDV (p = 0.002) and %∆LVMM (p = 0.02), whereas %∆LVESV and %∆LVEF were not significantly related to MACE (p > 0.05). The area under the curve (AUC) for the prediction of MACE was 0.76 (95% confidence interval [CI], 0.65–0.87) for %∆LVEDV (optimal cut-off 10%) and 0.69 (95%CI, 0.52–0.85) for %∆LVMM (optimal cut-off 5%). From all remodeling criteria, %∆LVEDV ≥ 10% showed highest hazard ratio (8.68 [95%CI, 2.39–31.56]; p = 0.001) for MACE. Regarding secondary endpoint (n = 35, 16%), also %∆LVEDV with an optimal threshold of 10% emerged as strongest prognosticator (AUC 0.66; 95%CI, 0.56–0.75; p = 0.004).ConclusionsFollowing revascularized STEMI, %∆LVEDV ≥ 10% showed strongest association with clinical outcome, suggesting this criterion as preferred CMR-based definition of post-STEMI LV remodeling.Key Points• CMR-determined %∆LVEDV and %∆LVMM were significantly associated with MACE following STEMI.• Neither %∆LVESV nor %∆LVEF showed a significant relation to MACE.• %∆LVEDV ≥ 10 was revealed as LV remodeling definition with highest prognostic validity.
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35 schema:keywords C-statistic
36 CMR
37 CMR criteria
38 Cox regression analysis
39 LV
40 LV end-diastolic volume
41 LV remodeling
42 Mann-Whitney U test
43 MethodsThis observational study
44 ST-elevation myocardial infarction
45 ST-elevation myocardial infarction (STEMI) patients
46 STEMI
47 U test
48 acute STEMI
49 adverse cardiovascular events
50 analysis
51 area
52 assessment
53 association
54 cardiovascular events
55 cardiovascular hospitalization
56 cause death
57 changes
58 clinical events
59 clinical outcomes
60 criteria
61 curves
62 death
63 definition
64 differences
65 ejection fraction
66 end-diastolic volume
67 end-systolic volume
68 endpoint
69 events
70 fraction
71 gold standard modality
72 hard clinical events
73 hazard ratio
74 high prognostic validity
75 higher hazard ratio
76 hospitalization
77 impact
78 incidence
79 incidence of MACE
80 infarction
81 infarction patients
82 magnetic resonance
83 major adverse cardiovascular events
84 mass
85 measures
86 modalities
87 months
88 myocardial infarction
89 myocardial infarction patients
90 myocardial mass
91 observational study
92 occurrence
93 optimal threshold
94 outcomes
95 patients
96 prediction
97 prediction of MACE
98 primary endpoint
99 prognostic impact
100 prognostic validity
101 prognosticator
102 ratio
103 regression analysis
104 relation
105 relative changes
106 remodeling
107 resonance
108 secondary endpoints
109 significant relation
110 stroke
111 strong association
112 strong prognosticator
113 study
114 test
115 threshold
116 validity
117 values
118 ventricular
119 ventricular remodeling
120 volume
121 weeks
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