Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction: An important prognostic indicator - 01/10/16
Abstract |
Objectives |
We sought to determine the relationship of adverse diastolic remodeling (ie, worsening diastolic or persistent restrictive filling) with infarct scar characteristics, and to evaluate its prognostic value after ST-segment elevation myocardial infarction (STEMI).
Background |
Severe diastolic dysfunction (restrictive filling) has known prognostic value post STEMI. However, ongoing left ventricular (LV) remodeling post STEMI may alter diastolic function even if less severe.
Methods and results |
There were 218 prospectively recruited STEMI patients with serial echocardiograms (transthoracic echocardiography) and cardiac magnetic resonance imaging (CMR) performed, at a median of 4 days (early) and 55 days (follow-up). LV ejection fraction and infarct characteristics were assessed by CMR, and comprehensive diastolic function assessment including a diastolic grade was evaluated on transthoracic echocardiography. ‘Adverse diastolic remodeling’ occurred if diastolic function grade either worsened (≥1 grade) between early and follow-up imaging, or remained as persistent restrictive filling at follow-up. Follow-up infarct scar size (IS) predicted adverse diastolic remodeling (area under the curve 0.86) and persistent restrictive filling (area under the curve 0.89). The primary endpoint of major adverse cardiovascular events (MACE) occurred in 48 patients during follow-up (mean, 710±79 days). Kaplan-Meier analysis showed that adverse diastolic remodeling (n=50) and persistent restrictive filling alone (n=33) were significant predictors of MACE (both P<.001). Multivariate Cox analysis, when adjusted for TIMI risk score and CMR IS, microvascular obstruction, and LV ejection fraction, showed adverse diastolic remodeling (HR 3.79, P<.001) was an independent predictor of MACE, as was persistent restrictive filling alone (HR 2.61, P=.019).
Conclusions |
Larger IS is associated with adverse diastolic remodeling. Following STEMI, adverse diastolic remodeling is a powerful prognostic marker, and identifies a larger group of ‘at-risk’ patients, than does persistent restrictive filling alone.
Le texte complet de cet article est disponible en PDF.Abbreviations : AUC, CMR, IS, LV, MACE, MVO, PCI, STEMI, TTE
Plan
| Sources of funding/Disclosures: TLN was supported by a National Health and Medical Research Council and National Heart Foundation postgraduate scholarship. The Cardiology department has received unrestricted educational grants from Biotronik, Medtronic and St Jude Medical. |
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| Conflict of interest: All other authors have no disclosures relevant to the contents of this manuscript. The authors are solely responsible for the design and conduct of this study all study analyses, the drafting and editing of the manuscript, and its final contents. |
Vol 180
P. 117-127 - octobre 2016 Retour au numéro
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