Left ventricular remodelling defined by LVEF < 50% at 6 months was significantly associated with long-term mortality (HR 2.78; 95% CI 1.41-5.48; P=0.003) in AMI patients undergoing PCI.
Observational (n=829)
Which echocardiographic definition of LV remodelling best predicts long-term mortality in AMI patients after PCI, and can it be predicted?
Among different definitions of LV remodelling after AMI, only LVEF < 50% at 6 months significantly predicts long-term all-cause mortality, which can be predicted using a 7-variable nomogram.
Effect estimate: HR 2.78 (95% CI 1.41-5.48)
p-value: p=0.003
AIMS: Left ventricular (LV) remodelling after acute myocardial infarction (AMI) is associated with heart failure and increased mortality. There was no consensus on the definition of LV remodelling, and the prognostic value of LV remodelling with different definitions has not been compared. We aimed to find the optimal definition and develop a prediction nomogram as well as online calculator that can identify patients at risk of LV remodelling. METHODS AND RESULTS: This prospective, observational study included 829 AMI patients undergoing percutaneous coronary intervention from January 2015 to January 2020. Echocardiography was performed within the 48 h of admission and at 6 months after infarction to evaluate LV remodelling, defined as a 20% increase in LV end-diastolic volume (LVEDV), a 15% increase in LV end-systolic volume (LVESV), or LV ejection fraction (LVEF) < 50% at 6 months. The impact of LV remodelling on long-term outcomes was analysed. Lasso regression was performed to screen potential predictors, and multivariable logistic regression analysis was conducted to establish the prediction nomogram. The area under the curve, calibration curve and decision curve analyses were used to determine the discrimination, calibration and clinical usefulness of the remodelling nomogram. The incidences of LV remodelling defined by LVEDV, LVESV and LVEF were 24.85% (n = 206), 28.71% (n = 238) and 14.60% (n = 121), respectively. Multivariable Cox regression models demonstrated that different definitions of LV remodelling were independently associated with the composite endpoint. However, only remodelling defined by LVEF was significantly connected with long-term mortality (hazard ratio = 2.78, 95% confidence interval 1.41-5.48, P = 0.003). Seven variables were selected to construct the remodelling nomogram, including diastolic blood pressure, heart rate, AMI type, stent length, N-terminal pro brain natriuretic peptide, troponin I, and glucose. The prediction model had an area under the receiver operating characteristics curve of 0.766. The calibration curve and decision curve analysis indicated consistency and better net benefit in the prediction model. CONCLUSIONS: LV remodelling defined by LVEDV, LVESV and LVEF were independent predictors for long-term mortality or heart failure hospitalization in AMI patients after percutaneous coronary intervention. However, only remodelling defined by LVEF was suitable for predicting all-cause death. In addition, the nomogram can provide an accurate and effective tool for the prediction of postinfarct remodelling.
Zhang et al. (Mon,) conducted a observational in acute myocardial infarction (n=829). Left ventricular remodelling definitions (LVEDV, LVESV, LVEF) was evaluated on long-term mortality (HR 2.78, 95% CI 1.41-5.48, p=0.003). Left ventricular remodelling defined by LVEF < 50% at 6 months was significantly associated with long-term mortality (HR 2.78; 95% CI 1.41-5.48; P=0.003) in AMI patients undergoing PCI.