Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Abstract

IntroductionThe study aimed to evaluate the prevalence and predictors of left ventricular (LV) reverse remodeling and its impact on long-term prognosis in patients with anterior ST-segment elevation myocardial infarction (STEMI).AimTo assess the percentage of reverse remodeling and its prognostic factors in anterior STEMI patients.Material and methodsThis observational study included 40 patients with first ever STEMI of the anterior wall. LV reverse remodeling was defined as the reduction of left ventricular end-systolic volume (ΔLVESV) by ≥ 10% in 3D transthoracic echocardiography (3D-TTE) at 3-month follow-up. 3D-TTE and speckle tracking imaging were performed during index hospitalization, while 3D-TTE and cardiac magnetic resonance (CMR) were performed at 3 months following the procedure. Patients were followed up for a median time of 3.4 years in order to evaluate major adverse cardiovascular events.ResultsLeft ventricular reverse remodeling at 3-month follow-up was confirmed in 15 (37.5%) patients. The presence of reverse remodeling was predicted by lower troponin levels (unit OR = 0.86, p = 0.02), lower sum of ST-segment elevations before (unit OR = 0.87, p = 0.03) and after PCI (unit OR = 0.40, p = 0.03), lower maximal ST-segment elevation after PCI (unit OR = 0.01, p = 0.03), lower wall motion score index (unit OR 0.40, p = 0.03) and more negative anterior wall global longitudinal strain (unit OR = 0.88, p = 0.045). Nine MACE were reported in the without reverse remodeling group only. Non-significantly better event-free survival in the reverse remodeling group was demonstrated (log-rank p = 0.07).ConclusionsDevelopment of reverse modeling in patients with optimal revascularization and tailored pharmacotherapy is relatively high. Further studies are warranted in order to adjudicate its prognostic role for the prediction of adverse events.

Effects and Safety of Sacubitril/Valsartan for Patients with Myocardial Infarction: A Systematic Review and Meta-Analysis

“…In recent years, due to the continuous expansion of chest pain centers in China, the mortality rate of AMI patients is significantly lower than before [ 2 ]. Although emergency PCI can revascularize and save part of dying and damaged myocardium, some patients could still experience left ventricular remodeling postmyocardial infarction [ 3 , 4 ]. Ventricular remodeling includes myocardial hypertrophy, interstitial fibrosis, increased cardiac volume, and reduced diastolic function.…”

Mid-regional pro-adrenomedullin and lactate dehydrogenase as predictors of left ventricular remodeling in patients with myocardial infarction treated with percutaneous coronary intervention

“…On the other hand, some patients after MI present restoration of LV geometry and recovery from initial LV dysfunction. A similar process was described in patients with chronic heart failure undergoing resynchronization therapy and was associated with favorable outcomes [8,10]. In that setting, this phenomenon was called reverse remodeling.…”

“…However, most recent therapies including early revascularization and pharmacotherapy targeted at neuro-hormonal pathways aim at preventing adverse remodeling and promoting reverse remodeling and improvement of LV function after MI. Reverse remodeling is considered to be triggered by early myocardial revascularization, conditioned by preserved microvascular flow and is associated with improved long-term outcome [8][9][10]. In the AMICI trial and study by Morishita et al reverse remodeling was assessed after 6 months from MI, like in our analysis [10,23].…”

“…The main impact of MI is shifting towards adverse remodeling, a process of alteration of left ventricle (LV) geometry and function, which could eventually lead to clinically apparent heart failure [1,[3][4][5][6][7]. On the other hand, due to early revascularization and pharmacotherapy, some patients after MI present recovery from initial LV dysfunction [8][9][10].…”

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

“…The values of LVEDV and LVESV were subsequently indexed to the body surface area (LVEDVI, LVESVI [ml/ m 2 ]). The wall motion score index was calculated for IRA territory (IRA-WMSI) [18]. Based on the current recommendations [17], a 16-segment model for LV segmentation and classification of territories supplied by each coronary artery were used.…”