TY - JOUR
T1 - Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction : an important prognostic indicator
AU - Nguyen, Tuan L.
AU - Phan, Justin
AU - Hogan, Jarred
AU - Hee, Leia
AU - Moses, Daniel
AU - Otton, James
AU - Premawardhana, Upal
AU - Rajaratnam, Rohan
AU - Juergens, Craig P.
AU - Dimitri, Hany
AU - French, John K.
AU - Richards, David
AU - Thomas, Liza
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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.
UR - https://hdl.handle.net/1959.7/uws:64637
U2 - 10.1016/j.ahj.2016.05.020
DO - 10.1016/j.ahj.2016.05.020
M3 - Article
SN - 0002-8703
VL - 180
SP - 117
EP - 127
JO - American Heart Journal
JF - American Heart Journal
ER -