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. 2017 Nov 27;12(11):e0188884.
doi: 10.1371/journal.pone.0188884. eCollection 2017.

Long-term prognostic impact of left ventricular remodeling after a first myocardial infarction in modern clinical practice

Christophe Bauters  1 , Emilie Dubois  2 , Sina Porouchani  3 , Eric Saloux  4 , Marie Fertin  3 , Pascal de Groote  1 , Nicolas Lamblin  1 , Florence Pinet  2
Affiliations

Long-term prognostic impact of left ventricular remodeling after a first myocardial infarction in modern clinical practice

Christophe Bauters et al. PLoS One. .

Abstract

Background: The association of left ventricular remodeling (LVR) after myocardial infarction (MI) with the subsequent risk of heart failure (HF) and death has not been studied in patients receiving optimal secondary prevention.

Methods and results: We performed a long-term clinical follow-up of patients included in 2 prospective multicentric studies on LVR after first anterior MI. At 1-year echocardiography, LVR (≥20% increase in end-diastolic volume from baseline to 1 year) occurred in 67/215 (31%) patients in cohort 1 and in 87/226 (38%) patients in cohort 2. The prescription rate of secondary prevention medications was very high (ß-blockers at 1 year: 90% and 95% for cohorts 1 and 2, respectively; angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE-I/ARB) at 1 year: 93% and 97% for cohorts 1 and 2, respectively). Median clinical follow-up after LVR assessment was 11.0 years in cohort 1 and 7.8 years in cohort 2. In both cohorts, LVR patients had a progressive increase in the risk of cardiovascular death or hospitalization for HF (p = 0.0007 in cohort 1 and 0.009 in cohort 2) with unadjusted hazard ratios of 2.52 [1.45-4.36] and 2.52 [1.23-5.17], respectively. Similar results were obtained when cardiovascular death was considered as an isolated endpoint. After adjustement on baseline characteristics including ejection fraction, the association with the composite endpoint was unchanged.

Conclusion: In a context of a modern therapeutic management with a large prescription of evidence-based medications, LVR remains independently associated with HF and cardiovascular death at long-term follow-up after MI.

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Conflict of interest statement

Competing Interests: Relationships with industry: C.B., travel grants from Amgen, Boehringer-Ingelheim, and MSD-Schering. E.S., consulting for Philips Research France; M.F., travel grants from Actelion, GlaxoSmithKline, MSD-Schering, Novartis, and consulting from Actelion, Novartis, and Vifor; P.d.G., fees for lectures or consulting from Actelion, Bayer, MSD-Schering, Novartis, Servier, Shire, and Vifor; N.L., research grant from Pfizer and fees for lectures or consulting from Actelion, Astra-Zeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, MSD-Schering, Novartis, Pfizer, and Sanofi-Aventis. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart of the study population.
MI, myocardial infaction; HTx, heart transplantation; echo F-up, echocardiographic follow-up; LVR, left ventricular remodeling defined as ≥20% change in left ventricular end-diastolic volume from baseline to 1-year.
Fig 2
Fig 2. Unadjusted Kaplan-Meier curves for the composite endpoint of cardiovascular death or hospitalization for HF.
The study population is divided in 2 groups according to LVR at 1-year follow-up (≥20% change in left ventricular end-diastolic volume from baseline to 1 year). Follow-up is starting at the time of 1-year echocardiography. A = cohort 1; B = cohort 2.
Fig 3
Fig 3. Unadjusted Kaplan-Meier curves for cardiovascular death.
The study population is divided in 2 groups according to LVR at 1-year follow-up (≥20% change in left ventricular end-diastolic volume from baseline to 1 year). Follow-up is starting at the time of 1-year echocardiography. A = cohort 1; B = cohort 2.
See this image and copyright information in PMC

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