Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance

作者：Bulluck Heerajnarain^*; Go Yun Yun; Crimi Gabriele; Ludman Andrew J; Rosmini Stefania; Abdel Gadir Amna; Bhuva Anish N; Treibel Thomas A; Fontana Marianna; Pica Silvia; Raineri Claudia; Sirker Alex; Herrey Anna S; Manisty Charlotte; Groves Ashley; Moon James C; Hausenloy Derek J

来源：Journal of Cardiovascular Magnetic Resonance, 2017, 19(1): 26.

DOI：10.1186/s12968-017-0343-9

• ST-segment elevation myocardial infarction
• LV remodeling
• trabeculae and papillary muscles
• LV end-diastolic volume
• LV end-systolic volume
• LV ejection fraction
• infarct size
• microvascular obstruction

Background: The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI.
Methods: Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 +/- 2 days) and follow-up (5 +/- 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%Delta LVEDV), LV end-systolic volume (%Delta LVESV), and LV ejection fraction (%Delta LVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF < 50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %Delta LVEDV and %Delta LVESV.
Results: The MDCs for %Delta LVEDV, %Delta LVESV, and %Delta LVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %Delta LVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %Delta LVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %Delta LVEDV and %Delta LVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened).
Conclusions: The MDCs for %Delta LVEDV and %Delta LVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %Delta LVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.

• 出版日期2017-3-13