Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI

Rodríguez-Palomares, José F.; Gavara, José; Ferreira‐González, Ignacio; Valente, Filipa; C, Ríos; Rodríguez-García, Julián; Bonanad, Clara; Blanco, Bruno García del; Miñana, Gema; Mutuberría, María; Núñez, Julio; Barrabés, José A.; Evangelista, Artur; Bodı́, Vicente; Garcı́a-Dorado, David

doi:10.1016/j.jcmg.2019.02.025

Cited by 78 publications

(52 citation statements)

References 39 publications

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“…In a recent CMR study of 498 STEMI patients, post‐infarct LV remodelling was not independently associated with the primary endpoint of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmias . LV remodelling was, however, still associated with an increased risk of cardiovascular mortality, heart failure hospitalization, and ventricular arrhythmias in the presence of a decrease in LVEF >3% . This concurs with our data, where no difference in mortality rates is seen between LV post‐infarct remodellers and non‐remodellers in both sexes and can most likely be attributed to the revolution in STEMI management that has occurred with replacement of pharmacological thrombolysis with primary PCI and the introduction of optimal medical therapy .…”

Section: Discussionsupporting

confidence: 90%

“…Although post‐infarct LV remodelling has been associated with secondary mitral regurgitation, ventricular arrhythmias, heart failure, and increased mortality in the past, modern treatment of STEMI with primary PCI and optimal medical therapy has improved the outcome considerably . In a recent CMR study of 498 STEMI patients, post‐infarct LV remodelling was not independently associated with the primary endpoint of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmias . LV remodelling was, however, still associated with an increased risk of cardiovascular mortality, heart failure hospitalization, and ventricular arrhythmias in the presence of a decrease in LVEF >3% .…”

Section: Discussionmentioning

confidence: 99%

“…LV remodelling is a complication that occurs in almost half of STEMI patients during the first year after the event, and it is caused by an inflammatory response, myocardial extracellular matrix degradation, muscle bundle slippage, and apoptosis . Although LV post‐infarct remodelling has been linked to increased mortality in the past, this does not appear to be the case in the current era of primary PCI and guideline‐directed medical therapy . Conflicting data exist on sex differences in LV post‐infarct remodelling .…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular remodelling after ST‐segment elevation myocardial infarction: sex differences and prognosis

et al. 2020

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Aims Left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) worsens outcome. The effect of sex on LV post-infarct remodelling is unknown. We therefore investigated the sex distribution and long-term prognosis of LV post-infarct remodelling after STEMI in the contemporary era of primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy. Methods and results Data were obtained from an ongoing primary PCI STEMI registry. LV remodelling was defined as ≥20% increase in LV end-diastolic volume at either 3, 6, or 12 months post-infarct, and LV remodelling impact on outcome was evaluated with a log-rank test. A total population of 1995 STEMI patients were analysed (mean age 60 ± 12 years): 1527 (77%) men and 468 (23%) women. The mean age of male patients was 60±11 versus 63±13 years for women (P < 0.001). A total of 953 (48%) patients experienced LV remodelling in the first 12 months of follow-up, and it was equally frequent amongst men (n = 729, 48%) and women (n = 224, 48%). After a median follow-up of 94 (interquartile range 69-119) months, 225 patients died: 171 (11%) men and 54 (12%) women. No survival difference was seen between remodellers and non-remodellers in the male (P = 0.113) and female (P = 0.920) groups. Conclusion LV post-infarct remodelling incidence, as well as long-term survival of LV remodellers and non-remodellers, was similar in men and women who were treated with primary PCI and optimal pharmacotherapy post-STEMI. Figure 2 Kaplan-Meier survival curves, according to sex and remodelling status. Time to cumulative survival in men (A) and women (B), according to the presence of left ventricular remodelling in the first 12 months after ST-segment elevation myocardial infarction. Post-STEMI remodelling, sex and outcome 479 ESC Heart Failure 2020; 7: 474-481

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left ventricular remodelling after ST‐segment elevation myocardial infarction: sex differences and prognosis

et al. 2020

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“…In consonance with our previous experience, LVEF decreases significantly from baseline to pre-injection (post-infarction) and suffers a progressive recovery from that time point to 10 weeks in all groups 6 . Similarly, in the clinical setting it has also been demonstrated that LVEF improves in most patients 1 month after infarction 46 . Myocardial stunning, defined as reversible myocardial dysfunction in regions of normal myocardial perfusion, has been pointed out as the most likely explanation for the increase in LVEF observed in all groups at 10 weeks compared with 2 days post-MI 47 .…”

Section: Discussionmentioning

confidence: 86%

Microencapsulated Insulin-Like Growth Factor-1 therapy improves cardiac function and reduces fibrosis in a porcine acute myocardial infarction model

Báez-Díaz

Blanco-Blázquez

Sánchez-Margallo

et al. 2020

Sci Rep

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Insulin-like growth factor-1 (IGF-1) has demonstrated beneficial effects after myocardial infarction (MI). Microencapsulation of IGF-1 could potentially improve results. We aimed to test the effect of an intracoronary (IC) infusion of microencapsulated IGF-1 in a swine acute MI model. For that purpose IC injection of a 10 ml solution of 5 × 10 6 IGF-1 loaded microspheres (MSPs) (n = 8, IGF-1 MSPs), 5 × 10 6 unloaded MSPs (n = 9; MSPs) or saline (n = 7; CON) was performed 48 hours post-MI. Left ventricular ejection fraction (LVEF), indexed ventricular volumes and infarct size (IS) were determined by cardiac magnetic resonance at pre-injection and 10 weeks. Animals were euthanized at 10 weeks, and myocardial fibrosis and vascular density were analysed. End-study LVEF was significantly greater in IGF-1 MSPs compared to MSPs and CON, while ventricular volumes exhibited no significant differences between groups. IS decreased over time in all groups. Collagen volume fraction on the infarct area was significantly reduced in IGF-1 MSPs compared to CON and MSPs. Vascular density analysis of infarct and border zones showed no significant differences between groups. In conclusion, the IC injection of 5 × 10 6 IGF-1 loaded MSPs in a porcine acute MI model successfully improves cardiac function and limits myocardial fibrosis, which could be clinically relevant.Cardiovascular diseases, especially ischemic heart disease, are the leading cause of mortality worldwide accounting for almost 4 million deaths a year in Europe 1,2 . Conventional treatments such as angioplasty and coronary stenting have contributed to reduce early mortality after an acute myocardial infarction (MI) 3 . However, such therapies are only palliative and do not recover the damaged myocardial tissue 4 , so that these diseases still represent a major unmet medical need.In the last two decades stem cell therapy has become a promising treatment option for ischemic cardiomyopathy 5 . As a result, the administration of various cell types has been proposed to address this problem but has shown only moderate improvements in cardiac function 6 .Recently, several studies suggest that the beneficial effect of stem cells does not lie in their multiplication, but in their paracrine actions 7 . Based on this insight, current research directions in regenerative cardiology are moving to a cell-less approach, since it is known now that stem cells are able to secrete combinations of biomolecules that modulate the composition of the damaged cardiac environment contributing to functional tissue repair by stimulating the migration, proliferation and survival of endogenous cardiac progenitor cells (eCSCs) 8,9 , as well as attenuating fibrosis and modulating inflammation 10,11 .Among the secreted substances, there are different cytokines, extracellular vesicles and growth factors including insulin-like growth factor-1 (IGF-1), hepatocyte growth factor (HGF), angiopoietin 2 or vascular endothelial 1

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“…In a recent study, Rodriguez-Palomares JF et al concluded that assessment of left ventricular remodeling at 6 months does not increase the prognostic value of the principal cardiac magnetic resonance (CMR) derived variables provided by the early CMR (18). Since access to CMR is limited, we believe that this nomogram, once validated, could offer a widely available, low-cost alternative to predict patients at risk of developing pathological left ventricular remodeling and do so in a very early stage of myocardial infarction (12 hours after reperfusion is achieved).…”

Section: Prospective Study Of Farah Et Al Included 66 Patients With mentioning

confidence: 99%

Nomogram Containing Simple Routine Clinical and Biochemical Parameters Can Predict Pathological Ventricular Remodeling in STEMI Patients

Vinter¹,

Kordić²,

Klobučar³

et al. 2020

Preprint

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BACKGROUND: Heart failure is the leading cause of worldwide morbidity and mortality, with ischemic heart disease being one of the most important etiologic factors. Heart failure develops due to ventricular remodeling, which leads to increases in left ventricular end-systolic and end-diastolic volumes.METHODS: We conducted a prospective observational study to find which parameters could predict the risk of pathological left ventricular remodeling in the early stage of myocardial infarction. RESULTS: We created a nomogram based on routinely used blood tests and vital parameters which had the highest correlation with pathological ventricular remodeling. The nomogram included NTproBNP value 12 hours after reperfusion, AST value 12 hours after reperfusion, systolic blood pressure value on admission and culprit coronary artery. We performed ROC analysis which found great predictive value of the nomogram. Area under curve (AUC) was 0,907 (95% CI 0,842 - 0,973). Nomogram value of -3.54 had sensitivity of 91.4% and specificity of 74.0%.CONCLUSION: We believe that this nomogram, once validated, could offer a widely available, low-cost option that would help identify patients at risk of developing pathological left ventricular remodeling and achieve this at a very early stage of myocardial infarction (12 hours after reperfusion is achieved).

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Prognostic Value of Initial Left Ventricular Remodeling in Patients With Reperfused STEMI

Cited by 78 publications

References 39 publications

Left ventricular remodelling after ST‐segment elevation myocardial infarction: sex differences and prognosis

Left ventricular remodelling after ST‐segment elevation myocardial infarction: sex differences and prognosis

Microencapsulated Insulin-Like Growth Factor-1 therapy improves cardiac function and reduces fibrosis in a porcine acute myocardial infarction model

Nomogram Containing Simple Routine Clinical and Biochemical Parameters Can Predict Pathological Ventricular Remodeling in STEMI Patients

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