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Left Ventricular Post-Infarct Remodeling: Implications for Systolic Function Improvement and Outcomes in the Modern Era.
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2019-12-11 , DOI: 10.1016/j.jchf.2019.08.014 Pieter van der Bijl 1 , Rachid Abou 1 , Laurien Goedemans 1 , Bernard J Gersh 2 , David R Holmes 2 , Nina Ajmone Marsan 1 , Victoria Delgado 1 , Jeroen J Bax 1
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2019-12-11 , DOI: 10.1016/j.jchf.2019.08.014 Pieter van der Bijl 1 , Rachid Abou 1 , Laurien Goedemans 1 , Bernard J Gersh 2 , David R Holmes 2 , Nina Ajmone Marsan 1 , Victoria Delgado 1 , Jeroen J Bax 1
Affiliation
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OBJECTIVES
This study sought to investigate the impact of post-infarct left ventricular (LV) remodeling on outcomes in the contemporary era.
BACKGROUND
LV remodeling after ST-segment elevation myocardial infarction (STEMI) is associated with heart failure and increased mortality. Pivotal studies have mostly been performed in the era of thrombolysis, whereas the long-term prognostic impact of LV remodeling has not been reinvestigated in the current era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.
METHODS
Data were obtained from an ongoing registry of patients with STEMI (all treated with primary PCI). Baseline, 3-month, 6-month, and 12-month echocardiograms were analyzed. LV remodeling was defined as a ≥20% increase in LV end-diastolic volume at 3, 6, or 12 months post-infarct. The impact of LV remodeling on outcomes was analyzed.
RESULTS
A total of 1,995 patients with STEMI were studied (mean age 60 ± 12 years, 77% men), 953 (48%) of whom demonstrated remodeling in the first 12 months of follow-up. After a median follow-up of 94 (interquartile range: 69 to 119) months, 225 (11%) patients had died. There was no difference in survival between remodelers and nonremodelers (p = 0.144). However, LV remodelers were more likely to be admitted to hospital for heart failure than were nonremodelers (p < 0.001).
CONCLUSIONS
In the contemporary era, in which STEMI is treated with primary PCI and optimal pharmacotherapy, almost one-half of patients demonstrate LV post-infarct remodeling. However, there is no difference in long-term survival between LV remodelers and nonremodelers, and LV remodelers experience a higher rate of heart failure hospitalization, which indicates the need to intensify preventative strategies in these patients.
中文翻译：
左室梗死后重塑：对现代时代的收缩功能改善和结果的影响。
目的本研究旨在探讨梗塞后左心室重构对当代时代结局的影响。背景技术ST段抬高型心肌梗死（STEMI）后的LV重塑与心力衰竭和死亡率增加有关。重要的研究大多是在溶栓时代进行的，而在目前的主要经皮冠状动脉介入治疗（PCI）和最佳药物治疗的时代，尚未对LV重塑的长期预后影响进行重新研究。方法数据来自进行中的STEMI患者（均接受原发性PCI治疗）。分析基线，3个月，6个月和12个月的超声心动图。左室重塑定义为梗死后3、6或12个月左室舒张末期容积增加≥20％。分析了左室重塑对结局的影响。结果共研究了1,995例STEMI患者（平均年龄60±12岁，男性为77％），其中953例（48％）在随访的前12个月表现出了重塑。在中位随访94个月（四分位间距：69到119）之后，有225名（11％）患者死亡。重塑者和非重塑者的生存率无差异（p = 0.144）。但是，与非改建者相比，LV改建者因心力衰竭入院的可能性更高（p <0.001）。结论在以原发性PCI和最佳药物治疗STEMI的现代时代，近一半的患者表现出梗死后左室重塑。但是，LV重塑者和非重塑者的长期生存率没有差异，
更新日期：2019-12-11
中文翻译：
左室梗死后重塑：对现代时代的收缩功能改善和结果的影响。
目的本研究旨在探讨梗塞后左心室重构对当代时代结局的影响。背景技术ST段抬高型心肌梗死（STEMI）后的LV重塑与心力衰竭和死亡率增加有关。重要的研究大多是在溶栓时代进行的，而在目前的主要经皮冠状动脉介入治疗（PCI）和最佳药物治疗的时代，尚未对LV重塑的长期预后影响进行重新研究。方法数据来自进行中的STEMI患者（均接受原发性PCI治疗）。分析基线，3个月，6个月和12个月的超声心动图。左室重塑定义为梗死后3、6或12个月左室舒张末期容积增加≥20％。分析了左室重塑对结局的影响。结果共研究了1,995例STEMI患者（平均年龄60±12岁，男性为77％），其中953例（48％）在随访的前12个月表现出了重塑。在中位随访94个月（四分位间距：69到119）之后，有225名（11％）患者死亡。重塑者和非重塑者的生存率无差异（p = 0.144）。但是，与非改建者相比，LV改建者因心力衰竭入院的可能性更高（p <0.001）。结论在以原发性PCI和最佳药物治疗STEMI的现代时代，近一半的患者表现出梗死后左室重塑。但是，LV重塑者和非重塑者的长期生存率没有差异，
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