Predictors of left ventricular remodeling after ST-elevation myocardial infarction

Abstract

Adverse left ventricular (LV) remodeling after acute ST-elevation myocardial infarction (STEMI) is associated with morbidity and mortality. We studied clinical, biochemical and angiographic determinants of LV end diastolic volume index (LVEDVi), end systolic volume index (LVESVi) and mass index (LVMi) as global LV remodeling parameters 4 months after STEMI, as well as end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT) of the non-infarcted myocardium, as compensatory remote LV remodeling parameters. Data was collected in 271 patients participating in the GIPS-III trial, presenting with a first STEMI. Laboratory measures were collected at baseline, 2 weeks, and 6-8 weeks. Cardiovascular magnetic resonance imaging (CMR) was performed 4 months after STEMI. Linear regression analyses were performed to determine predictors. At baseline, patients were 21% female, median age was 58 years. At 4 months, mean LV ejection fraction (LVEF) was 54 ± 9%, mean infarct size was 9.0 ± 7.9% of LVM. Strongest univariate predictors (all p < 0.001) were peak Troponin T for LVEDVi (R² = 0.26), peak CK-MB for LVESVi (R² = 0.41), NT-proBNP at 2 weeks for LVMi (R² = 0.24), body surface area for EDWT (R² = 0.32), and weight for ESWT (R² = 0.29). After multivariable analysis, cardiac biomarkers remained the strongest predictors of LVMi, LVEDVi and LVESVi. NT-proBNP but none of the acute cardiac injury biomarkers were associated with remote LV wall thickness. Our analyses illustrate the value of cardiac specific biochemical biomarkers in predicting global LV remodeling after STEMI. We found no evidence for a hypertrophic response of the non-infarcted myocardium.

Keywords: Left ventricular remodeling; Magnetic resonance imaging; Multivariable analysis; Myocardial infarction.

Fig. 1

ROC curves of strongest univariate predictor and multivariable model predicting deviations from P95 reference values. LVEDVi left ventricular end diastolic volume index, LVESVi left ventricular end systolic volume index, LVMi left ventricular mass index, ROC receiver operating characteristic, NT-proBNP N-terminal pro brain natriuretic peptide, HbA1c glycated hemoglobin, TIMI Thrombolysis in Myocardial Infarction, AUC area under the curve, CK creatine kinase, eGFR estimated glomerular filtration rate, CK creatine kinase, NT-proBNP N-terminal pro brain natriuretic peptide