Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Marek Grabka; Magdalena Kocierz-Woźnowska; Maciej Wybraniec; Maciej Turski; Marcin Wita; Krystian Wita; Katarzyna Mizia-Stec

doi:10.5114/aic.2018.79867

Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Postepy Kardiol Interwencyjnej. 2018;14(4):373-382. doi: 10.5114/aic.2018.79867. Epub 2018 Dec 11.

Authors

Marek Grabka¹, Magdalena Kocierz-Woźnowska², Maciej Wybraniec¹, Maciej Turski², Marcin Wita¹, Krystian Wita¹, Katarzyna Mizia-Stec¹

Affiliations

¹ 1 Department of Cardiology, Upper Silesian Medical Centre, Katowice, Poland.
² Department of Cardiac Rehabilitation, Upper Silesian Medical Centre, Katowice, Poland.

Abstract

Introduction: The study aimed to evaluate the prevalence and predictors of left ventricular (LV) reverse remodeling and its impact on long-term prognosis in patients with anterior ST-segment elevation myocardial infarction (STEMI).

Aim: To assess the percentage of reverse remodeling and its prognostic factors in anterior STEMI patients.

Material and methods: This observational study included 40 patients with first ever STEMI of the anterior wall. LV reverse remodeling was defined as the reduction of left ventricular end-systolic volume (ΔLVESV) by ≥ 10% in 3D transthoracic echocardiography (3D-TTE) at 3-month follow-up. 3D-TTE and speckle tracking imaging were performed during index hospitalization, while 3D-TTE and cardiac magnetic resonance (CMR) were performed at 3 months following the procedure. Patients were followed up for a median time of 3.4 years in order to evaluate major adverse cardiovascular events.

Results: Left ventricular reverse remodeling at 3-month follow-up was confirmed in 15 (37.5%) patients. The presence of reverse remodeling was predicted by lower troponin levels (unit OR = 0.86, p = 0.02), lower sum of ST-segment elevations before (unit OR = 0.87, p = 0.03) and after PCI (unit OR = 0.40, p = 0.03), lower maximal ST-segment elevation after PCI (unit OR = 0.01, p = 0.03), lower wall motion score index (unit OR 0.40, p = 0.03) and more negative anterior wall global longitudinal strain (unit OR = 0.88, p = 0.045). Nine MACE were reported in the without reverse remodeling group only. Non-significantly better event-free survival in the reverse remodeling group was demonstrated (log-rank p = 0.07).

Conclusions: Development of reverse modeling in patients with optimal revascularization and tailored pharmacotherapy is relatively high. Further studies are warranted in order to adjudicate its prognostic role for the prediction of adverse events.

Keywords: 3D transthoracic echocardiography; acute myocardial infarction/ST-segment elevation myocardial infarction; anterior global longitudinal strain; cardiac magnetic resonance imaging; global longitudinal strain; reverse remodeling.