Abstract 17995: Evolution of Left Ventricular Volume and Ejection Fraction in STEMI Patients: Findings From the PROMISE Randomized Clinical Trial
Introduction: Post-STEMI adverse left ventricular remodeling (AVR) is defined as an increase in end-diastolic left ventricular volume (EDLVV) without considering concomitant changes in left in ventricular ejection fraction (LVEF). We analyze the incidence and predictors of post STEMI AVR according to: A) Increase ≥15% in EDLVV (AVR), B) AVR and absence of increase in LVEF, and C) AVR and reduction of LVEF.
Methods: We analyzed clinical and MRI data from patients with STEMI and TIMI flow< 2 undergoing primary reperfusion within 6h and receiving intracoronary adenosine or placebo within the PROMISE clinical trial. 138 patients underwent MRI examinations between days 4 and 7 and after 6 months. Infarct size was measured by late gadolinium enhancement. The infarct transmurality index and the volume of myocardium with microvascular obstruction (MVO) were measured. Predictors of AVR without and with LVEF consideration were modeled by logistic regression.
Results: At 6 months, 52 out 138 (37.7%) patients showed an increase in EDLVV ≥15%. In 34 % of these (46.4%) LVEF remained unchanged (+/- 2%), and decreased >2% in 18 (34.6%) Moreover in 26 out 86 (30.2%) not increasing LVEDV ≥15% , LVEF decreased >2%. Predictors of AVR according to each of the three definitions investigated are presented in the table. Baseline EDLVV, gender, peak CK-Mb and MVO extension were associated to an increase of EDLVV ≥15%. When AVR required absence of increase in LVEF only CK-Mb was predictor, while only MVO predicted the combination of AVR and decreased LVEF.
Conclusion: In patients with STEMI reperfused within 6 hours, EDLVV increases in almost 38% over 6 months, but it is poor correlated with LVEF evolution, suggesting that changes in LVEF should be included in the definition of adverse remodeling. Peak Ck-MB and MVO extension are likely two potential candidates to identify patients with concomitant increase in LVEDV and decrease in LVEF reduction.
Author Disclosures: I. Ferreira-Gonzalez: None. J. Rodriguez-Palomares: None. V. Pineda: None. B. Garcia-del-Blanco: None. I. Otaegui: None. A. San-Roman: None. F. Fernandez-Aviles: None. J. Elizaga: None. J. Barrabes: None. D. Garcia-Dorado: None.
- © 2016 by American Heart Association, Inc.