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Patterns of left ventricular remodeling post-myocardial infarction, determinants, and outcome

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Abstract

Aim

Left ventricular remodeling (LVR) after myocardial infarction (MI) can lead to heart failure, arrhythmia, and death. We aim to describe adverse LVR patterns at 6 months post-MI and their relationships with subsequent outcomes and to determine baseline.

Methods and results

A multicenter cohort of 410 patients (median age 57 years, 87% male) with reperfused MI and at least 3 akinetic LV segments on admission was analyzed. All patients had transthoracic echocardiography performed 4 days and 6 months post-MI, and 214 also had cardiac magnetic resonance imaging performed on day 4. To predict LVR, machine learning methods were employed in order to handle many variables, some of which may have complex interactions. Six months post-MI, echocardiographic increases in LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were 14.1% [interquartile range 0.0, 32.0], 5.0% [− 14.0, 25.8], and 8.7% [0.0, 19.4], respectively. At 6 months, ≥ 15% or 20% increases in LVEDV were observed in 49% and 42% of patients, respectively, and 37% had an LVEF < 50%. The rate of death or new-onset HF at the end of 5-year follow-up was 8.8%. Baseline variables associated with adverse LVR were determined best by random forest analysis and included stroke volume, stroke work, necrosis size, LVEDV, LVEF, and LV afterload, the latter assessed by Ea or Ea/Ees. In contrast, baseline clinical and biological characteristics were poorly predictive of LVR. After adjustment for predictive baseline variables, LV dilation > 20% and 6-month LVEF < 50% were significantly associated with the risk of death and/or heart failure: hazard ratio (HR) 2.12 (95% confidence interval (CI) 1.05–4.43; p = 0.04) and HR 2.68 (95% CI 1.20–6.00; p = 0.016) respectively.

Conclusion

Despite early reperfusion and cardioprotective therapy, adverse LVR remains frequent after acute MI and is associated with a risk of death and HF. A machine learning approach identified and prioritized early variables that are associated with adverse LVR and which were mainly hemodynamic, combining LV volumes, estimates of systolic function, and afterload.

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Data availability

The data underlying this article will be shared by the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to Pelle Stolt PhD for help with manuscript editing.

Funding

The grant from a clinical research program, provided by the French government.

Author information

Authors and Affiliations

  1. UMR-S 942 MASCOT, Université Paris Cité and Inserm, Paris, France

    Damien Logeart, Jean-Marie Launay, Nicolas Vodovar & Eric Vicaut

  2. Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière-Fernand Widal, 75010, Paris, France

    Damien Logeart, Yoann Taille & Eric Vicaut

  3. Assistance Publique Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France

    Geneviève Derumeaux

  4. ELSAN - Polyclinique de Poitiers, Poitiers, France

    Barnabas Gellen

  5. American Hospital, Neuilly-Sur-Seine, France

    Marc Sirol

  6. Rangeuil Universitary Hospital, Toulouse, France

    Michel Galinier

  7. Arnaud de Villeneuve Universitary Hospital, Montpellier, France

    François Roubille

  8. Andre Mignot Hospital, Versailles, France

    Jean-Louis Georges

  9. Universitary Hospital, Nantes, France

    Jean-Noël Trochu

  10. Institut Cœur Poumons, Universitary Hospital, Lille, France

    Christophe Bauters

  11. Université Paris Cité, Paris, France

    Damien Logeart, Eric Vicaut & Jean-Jacques Mercadier

  12. Inserm UMR-S 1180, Orsay, France

    Jean-Jacques Mercadier

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  1. Damien Logeart
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Correspondence to Damien Logeart.

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Logeart, D., Taille, Y., Derumeaux, G. et al. Patterns of left ventricular remodeling post-myocardial infarction, determinants, and outcome. Clin Res Cardiol (2024). https://doi.org/10.1007/s00392-023-02331-z

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