Prediction of Adverse Post-Infarction Left Ventricular Remodeling Using a Multivariate Regression Model

Abstract

Background. In order to provide personalized medicine and improve cardiovascular outcomes, a method for predicting adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI) is needed. Methods. A total of 125 STEMI patients, mean age 51.2 (95% CI 49.6; 52.7) years were prospectively enrolled. The clinical, laboratory, and instrumental examinations were performed between the 7th and 9th day, and after 24 and 48 weeks, including plasma analysis of brain natriuretic peptide (BNP), transthoracic echocardiography, analysis of left ventricular-arterial coupling, applanation tonometry, ultrasound examination of the common carotid arteries with RF signal amplification. Results. Patients were divided into 2 groups according to echocardiography: “ALVR” (n = 63)—end-diastolic volume index (EDVI) >20% and/or end-systolic volume index (ESVI) >15% after 24 weeks compared with initial values; “non-ALVR” (n = 62)—EDVI <20% and ESVI <15%. In the ALVR group, hard endpoints (recurrent myocardial infarction, unstable angina, hospitalization for decompensated heart failure, ventricular arrhythmias, cardiac surgery, cardiovascular death) were detected in 19 people (30%). In the non-ALVR group, hard endpoints were noted in 3 patients (5%). The odds ratio of developing an adverse outcome in ALVR vs. non-ALVR group was 8.5 (95% CI 2.4–30.5) (p = 0.0004). According to the multivariate analysis, the contribution of each of the indicators to the relative risk (RR) of adverse cardiac remodeling: waist circumference, RR = 1.02 (95% CI 1.001–1.05) (p = 0.042), plasma BNP—RR = 1.81 (95% CI 1.05–3.13) (p = 0.033), arterial elastance to left ventricular end-systolic elastance (Ea/Ees)—RR = 1.96 (95% CI 1.11–3.46) (p = 0.020). Conclusion. Determining ALVR status in early stages of the disease can accurately predict and stratify the risk of adverse outcomes in STEMI patients.

Association of aortic stiffness early post myocardial infarction with left ventricular remodelling

“…Left ventricular remodelling is characterized by a sum of genetic, molecular, cellular and interstitial changes with subsequent alterations in cardiac size, shape and function after myocardial injury such as an ischemic event 20 . A recent study demonstrated that the development of adverse LV remodelling post myocardial infarction is related with an 8.5‐fold increase in the risk of cardiovascular events during a 48‐week follow‐up period 21 . Conversely, even minor reductions in LV remodelling can be associated with a decreased risk of heart failure and cardiovascular death 22 .…”

“…Furthermore, Oleynikov et al have showed the predictive value of LV‐arterial coupling, defined as the ratio of arterial elastance to LV end‐systolic elastance, in the development of adverse LV remodelling (relative risk = 1.96, 95% CI: 1.11–3.46, p = .020) 21 . However, a recently published study demonstrated that PWV/GLS ratio was importantly associated with cardiovascular factors regardless of age and thus should preferably be used to assess ventricular‐arterial interaction over other traditional echocardiography‐derived markers 15 .…”

“…20 A recent study demonstrated that the development of adverse LV remodelling post myocardial infarction is related with an 8.5-fold increase in the risk of cardiovascular events during a 48-week follow-up period. 21 Conversely, even minor reductions in LV remodelling can be associated with a decreased risk of heart failure and cardiovascular death. 22 On the contrary, reverse LV remodelling is defined as a process characterized by a decrease in LV volumes resulting in a significant restoration of systolic and diastolic cardiac function after timely revascularization.…”

“…27 Furthermore, Oleynikov et al have showed the predictive value of LV-arterial coupling, defined as the ratio of arterial elastance to LV end-systolic elastance, in the development of adverse LV remodelling (relative risk = 1.96, 95% CI: 1.11-3.46, p = .020). 21 However, a recently published study demonstrated that PWV/GLS ratio was importantly associated with cardiovascular factors regardless of age and thus should preferably be used to assess ventricular-arterial interaction over other traditional echocardiography-derived markers. 15 In line with these studies, we found in the current study that higher baseline PWV, and impaired PWV/ GLS ratio, as a surrogate marker of ventricular-arterial interaction, are associated with absence of reverse LV remodelling at 2 years post myocardial infarction.…”

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

“…Objective assessment of hemodynamic conditions is fundamental to guide the clinical management of the cardiac surgery patient during the postoperative period [ 1 , 2 , 3 ]. Meticulous fluid management is crucial in patients undergoing cardiac surgery, particularly in those with heart failure; prolonged operative and aortic cross-clamp time; or preexisting kidney, lung, or liver dysfunction [ 4 , 5 ]. Recent studies suggested that abdominal congestion can lead to or worsen renal and hepatic dysfunction and thus increase the risk of postoperative complications and lead to higher resource utilization [ 6 , 7 ].…”