0195: Early predictive factors of LV remodeling after STEMI; assessment by coronary angiogram and cadiovascular magnetic resonance

Abstract

Several months after acute ST elevation myocardial infarction (STEMI), many patients will develop left ventricular (LV) remodeling and heart failure. The aim of this study was to identify early predictive factors for LV remodeling (LVR) assessed by coronary angiogram and cardiovascular magnetic resonance (CMR) after STEMI. We prospectively included 52 patients with a first STEMI. All patients were successfully revascularized within 12 hours of chest pain onset using percutaneous coronary intervention (PCI). Angiographic parameters such as TIMI flow and blush grade were recorded. Index of microvascular resistance (IMR) was measured immediately after successful reperfusion. CMR was performed at days 4+/-2 days and at 6 months after STEMI. Comprehensive CMR included cine, T2-weighted, and late gadolinium enhancement (LGE) imaging allowing assessment of ventricular function, infarct size (IS), microvascular obstruction (MVO) and myocardial haemorrhage. LVR was defined as a >20% increase of LV volume at 6 months. LVR was observed in 34.8% of the patients (18/52). TIMI flow and blush grade after PCI was not different between patients with and without LVR (3 and 2 for TIMI flow and 2 and 2 for Blush grade respectively, p=0.952). However the IMR level markedly differed between patients with and without LVR (73,95 vs. 27,23 p=0,0293). After multivariate analysis IMR>40 was the strongest angiographic factor to predict LVR (OR 15 (1,030-218,4), p=0,03). Regarding CMR, patients with LVR had lower LVEF (43% vs. 48%; p=0.01), larger IS (51 mg vs 32 mg; p=0.002) and greater MVO extent (4.5seg vs. 2seg; p=0.03) when compared to patients with no LVR. IMR assessed by coronary angiogram, as well as IS and MVO extent assessed by CMR, are strong predictive factors of LV remodeling 6 months after STEMI.