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. 2022 Apr;9(2):912-924.
doi: 10.1002/ehf2.13802. Epub 2022 Jan 22.

Functional classification of left ventricular remodelling: prognostic relevance in myocardial infarction

Surenjav Chimed  1 , Pieter van der Bijl  1 , Rodolfo Lustosa  1 , Federico Fortuni  1 , Jose M Montero-Cabezas  1 , Nina Ajmone Marsan  1 , Bernard J Gersh  2 , Victoria Delgado  1 , Jeroen J Bax  1   3
Affiliations

Functional classification of left ventricular remodelling: prognostic relevance in myocardial infarction

Surenjav Chimed et al. ESC Heart Fail. 2022 Apr.

Abstract

Aims: The current definition of post ST-segment elevation myocardial infarction (STEMI) left ventricular (LV) remodelling is purely structural (LV dilatation) and does not consider LV function (ejection fraction, EF), even though it is known to be a predictor of long-term post-STEMI outcome. This study aimed to reclassify LV remodelling after STEMI by integrating LV dilatation and function (LVEF) and to investigate the prognostic implications.

Methods and results: Data from an ongoing registry of STEMI patients who were treated with primary percutaneous coronary intervention (PCI) were retrospectively evaluated. Four distinct remodelling subgroups were identified: (i) no LV dilatation, no LVEF impairment,(ii) no LV dilatation but LVEF impairment, (iii) LV dilatation but no LVEF impairment, and (iv) LV dilatation and LVEF impairment. The impact of functional LV remodelling on outcomes was analysed. A total of 2346 patients were studied (mean age 60 ± 11 years, 76% men). During a median follow-up of 76 (interquartile range 52 to 107) months, 282 (12%) died, while the composite of death and heart failure hospitalization occurred in 305 (13%) patients. Those with LV remodelling and LVEF impairment had a significantly lower survival rate (P < 0.001) and event-free survival rate (P < 0.001) compared with other functional LV remodelling groups.

Conclusions: Employing a functional LV post-infarct remodelling classification has the potential to improve risk stratification beyond structural LV remodelling alone. Identification of patients with the worst prognosis by using a functional LV remodelling approach may allow institution of early preventative therapies.

Keywords: HF hospitalization; STEMI; mortality; prognosis; remodelling.

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Conflict of interest statement

The Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre has received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Ionis and Medtronic. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, Medtronic, MSD, and Novartis. Nina Ajmone Marsan received speaker fees from Abbott Vascular and GE Healthcare. Jeroen J. Bax received speaker fees from Abbott Vascular.

Figures

Figure 1
Figure 1
Spline curves for all‐cause mortality (A) and the composite of all‐cause mortality and HF hospitalization (B) across a range of absolute change in LVEF, plotted as a hazard ratio with overlaid 95% confidence intervals. CI, confidence interval; HF, heart failure; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
The occurrence of all‐cause mortality (blue circles) (A), the composite of all‐cause mortality and HF hospitalization (green circles) (B) and patients without events (grey circles) across the functional LV remodelling groups. Horizontal dashed line corresponds to the LVEF threshold used for the definition of remodelling groups, while the vertical dashed line corresponds to the LVEDV value used in the definition of remodelling groups. HF, heart failure; LV, left ventricular; LVEF, LV ejection fraction; LVEDV, LV end‐diastolic volume.
Figure 3
Figure 3
Kaplan–Meier curves for all‐cause mortality (A) and the composite of all‐cause mortality and HF hospitalization (B), stratified according to functional LV remodelling group. HF, heart failure; LV, left ventricular.
Figure 4
Figure 4
Interaction between change in LVEDV and change in LVEF for all‐cause mortality (A) and the composite of all‐cause mortality and HF hospitalization (B). HF, heart failure; LV, left ventricular; LVEDV, LV end‐diastolic volume; LVEF, LV ejection fraction. The interaction between these two variables is confirmed by the non‐parallel nature of the curves.
Figure 5
Figure 5
Likelihood ratio test for the incremental value of functional classification of LV remodelling for all‐cause mortality (A) and the composite of all‐cause mortality and HF hospitalization (B). BSA, body surface area; CAD, coronary artery disease; DM, diabetes mellitus; EDV, end‐diastolic volume; ESV, end‐systolic volume; MI, myocardial infarction; TnI, troponin I; MVD, multivessel disease; DBP, diastolic blood pressure; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; LV, left ventricular.
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