Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI
Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI
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DOI：
10.1016/j.jcmg.2019.02.025
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发表时间：
2019-12-01
影响因子：
14
通讯作者：
Garcia-Dorado, David
中科院分区：
文献类型：
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作者：
Rodriguez-Palomares, Jose F.;Gavara, Jose;Garcia-Dorado, David
目的建立左心室逆重构(LVAR)的最佳定义以预测预后，并确定其评估是否能提供早期心脏磁共振(CMR)的预后信息。背景LVAR通常被定义为ST段抬高的心肌梗死后心力衰竭的主要原因，但LVAR在预测心血管事件中的作用仍存在争议。分别在住院期间(6.2±2.6天)和6个月后(6.1±1.8个月)进行CMR检查。确定了与主要终点相关的LVEDV增大和LV射血分数减小的最佳阈值。主要结果包括心血管死亡率、因心力衰竭住院或室性心律失常。49例患者在随访期间(72.9+/-42.8个月)出现主要终点。最大限度地提高识别有无结果的患者的能力的价值是左心室射血分数相对增加了15%(风险比[HR]：2.1p=0.007)，左心室射血分数相对下降了3%(HR：2.5p=0.001)。然而，预测模型(使用C统计分析)未能证明在6个月时直接观察LVAR在预测预后方面为早期CMR的数据增加了信息(C统计：0.723比0.795)。结论最佳预测不良心血管事件的LVAR的定义应同时考虑LVEDV的增加和LV射血分数的减少。然而，对LVAR的评估并不能改善早期CMR提供的信息。(C)2019年提交人。由爱思唯尔公司代表美国心脏病学会基金会出版。
OBJECTIVES This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR).BACKGROUND LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial.METHODS Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 +/- 2.6 days) and after 6 months (6.1 +/- 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia.RESULTS The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 +/- 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795).CONCLUSIONS The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.