TY - JOUR
T1 - Left Ventricular Post-Infarct Remodeling
T2 - Implications for Systolic Function Improvement and Outcomes in the Modern Era
AU - van der Bijl, Pieter
AU - Abou, Rachid
AU - Goedemans, Laurien
AU - Gersh, Bernard J.
AU - Holmes, David R.
AU - Ajmone Marsan, Nina
AU - Delgado, Victoria
AU - Bax, Jeroen J.
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/2
Y1 - 2020/2
N2 - Objectives: This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era. Background: LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombolysis, whereas the long-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy. Methods: Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed. Results: A total of 1,995 patients with STEMI were studied (mean age 60 ± 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartile range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001). Conclusions: In the contemporary era, in which STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients.
AB - Objectives: This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era. Background: LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombolysis, whereas the long-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy. Methods: Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed. Results: A total of 1,995 patients with STEMI were studied (mean age 60 ± 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartile range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001). Conclusions: In the contemporary era, in which STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients.
KW - LV remodeling
KW - post-infarct
KW - prognosis
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U2 - 10.1016/j.jchf.2019.08.014
DO - 10.1016/j.jchf.2019.08.014
M3 - Article
C2 - 31838030
AN - SCOPUS:85078042918
SN - 2213-1779
VL - 8
SP - 131
EP - 140
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 2
ER -