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

This study sought to establish the best definition of left ventricular adverse remodeling (LVAR) to predict outcomes and determine whether its assessment adds prognostic information to that obtained by early cardiac magnetic resonance (CMR). LVAR, usually defined as an increase in left ventricular end-diastolic volume (LVEDV) is the main cause of heart failure after an ST-segment elevated myocardial infarction; however, the role of assessment of LVAR in predicting cardiovascular events remains controversial. Patients with ST-segment elevated myocardial infarction who received percutaneous coronary intervention within 6 h of symptom onset were included (n = 498). CMR was performed during hospitalization (6.2 ± 2.6 days) and after 6 months (6.1 ± 1.8 months). The optimal threshold values of the LVEDV increase and the LV ejection fraction decrease associated with the primary endpoint were ascertained. Primary outcome was a composite of cardiovascular mortality, hospitalization for heart failure, or ventricular arrhythmia. The study was completed by 374 patients. Forty-nine patients presented the primary endpoint during follow-up (72.9 ± 42.8 months). Values that maximized the ability to identify patients with and without outcomes were a relative rise in LVEDV of 15% (hazard ratio [HR]: 2.1; p = 0.007) and a relative fall in LV ejection fraction of 3% (HR: 2.5; p = 0.001). However, the predictive model (using C-statistic analysis) failed to demonstrate that direct observation of LVAR at 6 months adds information to data from early CMR in predicting outcomes (C-statistic: 0.723 vs. 0.795). The definition of LVAR that best predicts adverse cardiovascular events should consider both the increase in LVEDV and the reduction in LV ejection fraction. However, assessment of LVAR does not improve information provided by the early CMR.

Rodriguez-Palomares JF ，Gavara J ，Ferreira-González I ，Valente F ，Rios C ，Rodríguez-García J ，Bonanad C ，García Del Blanco B ，Miñana G ，Mutuberria M ，Nuñez J ，Barrabés J ，Evangelista A ，Bodí V ，García-Dorado D ... -  《-》

Prognosis-based definition of left ventricular remodeling after ST-elevation myocardial infarction.

Reindl M ，Reinstadler SJ ，Tiller C ，Feistritzer HJ ，Kofler M ，Brix A ，Mayr A ，Klug G ，Metzler B ... -  《-》

Redefining Adverse and Reverse Left Ventricular Remodeling by Cardiovascular Magnetic Resonance Following ST-Segment-Elevation Myocardial Infarction and Their Implications on Long-Term Prognosis.

Bulluck H ，Carberry J ，Carrick D ，McEntegart M ，Petrie MC ，Eteiba H ，Hood S ，Watkins S ，Lindsay M ，Mahrous A ，Ford I ，Oldroyd KG ，Berry C ... -  《-》

Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Prediction of Cardiovascular Events Following Myocardial Infarction.

The aims of the study were to assess the prognostic significance of cardiac magnetic resonance myocardial feature tracking (CMR-FT) in a large multicenter study and to evaluate the most potent CMR-FT predictor of hard clinical events following myocardial infarction (MI). CMR-FT is a new method that allows accurate assessment of global and regional circumferential, radial, and longitudinal myocardial strain. The prognostic value of CMR-FT in patients with reperfused MI is unknown. The study included 1,235 MI patients (n = 795 with ST-segment elevation MI and 440 with non-ST-elevation MI) at 15 centers. All patients were reperfused by primary percutaneous coronary intervention. Central core laboratory-masked analyses were performed to determine left ventricular (LV) circumferential, radial, and longitudinal strain. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events within 12 months after infarction. Patients with cardiovascular events had significantly impaired CMR-FT strain values (p < 0.001 for all). Global longitudinal strain was identified as the strongest CMR-FT parameter of future cardiovascular events and emerged as an independent predictor of poor prognosis following MI even after adjustment for established prognostic markers. Global longitudinal strain provided an incremental prognostic value for all-cause mortality above LV ejection fraction (c-index increase from 0.65 to 0.73; p = 0.04) and infarct size (c-index increase from 0.60 to 0.78; p = 0.002). CMR-FT is a superior measure of LV function and performance early after reperfused MI with incremental prognostic value for mortality over and above LV ejection fraction and infarct size. (Abciximab i.v. Versus i.c. in ST-segment elevation Myocardial Infarction [AIDA STEMI]; NCT00712101; Thrombus Aspiration in ThrOmbus Containing culpRIT Lesions in Non-ST-Elevation Myocardial Infarction [TATORT-NSTEMI]; NCT01612312).

Eitel I ，Stiermaier T ，Lange T ，Rommel KP ，Koschalka A ，Kowallick JT ，Lotz J ，Kutty S ，Gutberlet M ，Hasenfuß G ，Thiele H ，Schuster A ... -  《-》

Is cardiac magnetic resonance necessary for prediction of left ventricular remodeling in patients with reperfused ST-segment elevation myocardial infarction?

Kim EK ，Song YB ，Chang SA ，Park SJ ，Hahn JY ，Choi SH ，Choi JH ，Gwon HC ，Park SW ，Choe YH ，Ahn J ，Carriere K ，Lee SC ... -  《-》