Left Ventricular Adverse Remodeling in Ischemic Heart Disease: Emerging Cardiac Magnetic Resonance Imaging Biomarkers

Abstract

Post-ischemic left ventricular (LV) remodeling is a biologically complex process involving myocardial structure, LV shape, and function, beginning early after myocardial infarction (MI) and lasting until 1 year. Adverse remodeling is a post-MI maladaptive process that has been associated with long-term poor clinical outcomes. Cardiac Magnetic Resonance (CMR) is the best tool to define adverse remodeling because of its ability to accurately measure LV end-diastolic and end-systolic volumes and their variation over time and to characterize the underlying myocardial changes. Therefore, CMR is the gold standard method to assess in vivo myocardial infarction extension and to detect the presence of microvascular obstruction and intramyocardial hemorrhage, both associated with adverse remodeling. In recent times, new CMR quantitative biomarkers emerged as predictive of post-ischemic adverse remodeling, such as T1 mapping, myocardial strain, and 4D flow. Additionally, CMR T1 mapping imaging may depict infarcted tissue and assess diffuse myocardial fibrosis by using surrogate markers such as extracellular volume fraction, which may predict functional recovery or risk stratification of remodeling. Finally, there is emerging evidence supporting the utility of intracavitary blood flow kinetic energy and hemodynamic features assessed by the 4D flow CMR technique as early predictors of remodeling.

Predicting left ventricular remodeling post-MI through coronary physiological measurements based on computational fluid dynamics

“…In the context of predicting adverse remodeling in patients with STEMI, previous investigations have relied heavily on CMR imaging features such as myocardial strain, MVO, and infarct size. 9 , 24 , 25 , 26 However, the widespread use of CMR is hampered by the need for contrast agents and the presence of contraindications. Coronary angiography is essential for patients with STEMI undergoing PPCI and plays a crucial role in guiding interventions and assessing coronary artery involvement, as highlighted in the guidelines for the management of acute coronary syndromes.…”

Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain

“…Furthermore, the implication of iPPM in the post-ischemic LV remodeling process is still controversial [ 2 , 32 , 33 ]. Many studies have demonstrated that multiple factors play a role in this complex adaptative phenomenon by using CMR [ 34 ]. However, it is still unknown if iPPM may facilitate adverse remodeling or the redistribution of intracavitary hemodynamic forces, which appears to be one of the leading mechanisms of remodeling [ 35 ].…”

PFKFB3 Inhibitor 3PO Reduces Cardiac Remodeling after Myocardial Infarction by Regulating the TGF-β1/SMAD2/3 Pathway

“…LV remodeling following MI usually continues for weeks or months, which results in changes to the structure, size, and function of the LV and plays a crucial role in the development of heart failure. In addition, LV remodeling affects the entire cavity and is linked to the growth of the chambers and time-dependent changes in the form of the heart, from elliptic to spheric [45,46]. To investigate the function of PFKFB3 in long-term ventricular remodeling following MI, we used 3PO, a specific small molecule inhibitor of PFKFB3.…”