Key result
Higher diastolic L-S/A-B force ratio is linked to ~10% higher odds of post-STEMI adverse LV remodelling.
Why the study?
Altered left ventricular haemodynamic forces have been linked to remodelling, but specific patterns associated with adverse left ventricular remodelling in reperfused STEMI patients remained to be identified.
Does misalignment of diastolic haemodynamic forces predict adverse left ventricular remodelling in reperfused STEMI patients?
Cohort (n=49)
Does misalignment of diastolic haemodynamic forces predict adverse left ventricular remodelling in reperfused STEMI patients?
Odds Ratio: 1.1 (95% CI 1.01–1.2)
p-value: p=0.04
CMR-derived misalignment of diastolic haemodynamic forces is an early independent predictor of adverse left ventricular remodelling post-STEMI, potentially identifying patients needing aggressive heart failure prevention.
Diastolic L-S/A-B HDF ratio may flag remodelling risk after STEMI; leaves open incremental prognostic value beyond infarct size in larger cohorts.
AIMS: Altered left ventricular (LV) haemodynamic forces (HDFs) have been associated with positive and negative remodelling after pathogenic or therapeutic events. We aimed to identify LV HDFs patterns associated with adverse LV remodelling (aLVr) in reperfused segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS: Forty-nine acute STEMI patients underwent cardiac magnetic resonance (CMR) at 1 week (baseline) and after 4 months (follow-up). LV HDFs were computed at baseline from cine CMR long axis data sets, using a novel technique based on endocardial boundary tracking, both in apex-base (A-B) and latero-septal (L-S) directions. HDFs distribution was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). HDFs parameters were computed over the entire heartbeat, in systole and diastole. At baseline, aLVr patients had lower systolic L-S HDF (2.7 ± 0.9 vs. 3.6 ± 1%; P = 0.027) and higher diastolic L-S/A-B HDF ratio (28 ± 14 vs. 19 ± 6%; P = 0.03). At univariate logistic regression analysis, higher infarct size [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01-1.1; P = 0.04], higher L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01-1.2; P = 0.05) and lower L-S HDFs (OR 0.41; 95% CI 0.2-0.9; P = 0.04) were associated with aLVr at follow-up. In the multivariable logistic regression analysis, diastolic L-S/A-B HDF ratio remained the only independent predictor of aLVr (OR 1.1; 95% CI 1.01-1.2; P = 0.04). CONCLUSIONS: Misalignment of diastolic haemodynamic forces after STEMI is associated with aLVr after 4 months.
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Filomena et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=49). Higher diastolic latero-septal over apex-base haemodynamic forces (L-S/A-B) ratio vs. Lower diastolic L-S/A-B HDF ratio was evaluated on Adverse left ventricular remodelling (aLVr) at 4 months (OR 1.1, 95% CI 1.01-1.2, p=0.04). Higher diastolic L-S/A-B haemodynamic force ratio was an independent predictor of adverse left ventricular remodelling at 4 months following STEMI (OR 1.1, 95% CI 1.01-1.2, P=0.04).
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