The following is a summary of “Patterns of left ventricular remodeling post-myocardial infarction, determinants, and outcome,” published in the January 2024 issue of Cardiology by Logeart et al.

Left ventricular remodeling (LVR) following myocardial infarction (MI) may result in heart failure (HF), arrhythmias, and mortality.

Researchers conducted a retrospective study to elucidate unfavorable LVR patterns 6 months post-MI, examining their connections with subsequent outcomes and identifying baseline factors.

They analyzed 410 patients (median age: 57 years, 87% male) who experienced reperfused MI and had at least 3 akinetic left ventricular (LV) segments upon admission. All individuals underwent transthoracic echocardiography 4 days and 6 months post-MI, with 214 also undergoing cardiac magnetic resonance imaging on day 4. Machine learning methods were employed to predict LVR, handling numerous variables with potentially complex interactions.

The results showed 6 months post-MI, echocardiographic changes in LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF), LVEDV increased by 14.1% (IQR 0.0, 32.0), LVESV increased by 5.0% (−14.0, 25.8), and LVEF increased by 8.7% (0.0, 19.4). At 6 months, 49% and 42% of patients exhibited ≥15% and 20% increases in LVEDV, respectively, and 37% had an LVEF < 50%. The incidence of death or new-onset HF over a 5-year follow-up period was 8.8%. Random forest analysis identified baseline variables associated with adverse LVR, including stroke volume, work, necrosis size, LVEDV, LVEF, and LV afterload (assessed by Ea or Ea/Ees). The baseline clinical and biological characteristics poorly predicted LVR. Following adjustment for predictive baseline variables, LV dilation > 20% and 6-month LVEF< 50% were significantly associated with the risk of death and HF, with HR of 2.12 (95% Cl 1.05–4.43; P=0.04) and 2.68 (95% CI 1.20–6.00; P=0.016).

Investigators concluded that early reperfusion and cardioprotective therapy notwithstanding, adverse LVR post-acute MI persists, correlating with increased risk of death and HF. 

Source: link.springer.com/article/10.1007/s00392-023-02331-z