Early remodeling processes as predictors of diastolic function 5 years after reperfused acute myocardial infarction and intracoronary progenitor cell application

Abstract

Ischemia-induced left ventricular (LV) diastolic dysfunction (DD) is increasingly recognized as a therapeutic challenge. While DD during acute myocardial infarction (AMI) determines patients' prognosis, it is unknown how LV remodeling after AMI affects the development of DD. Therefore, we aimed to identify AMI characteristics, which determine diastolic function after 5years. 41 patients with reperfused AMI and intracoronary infusion of progenitor cells were included into the present analysis of the TOPCARE-AMI trial. At 5-year follow-up, we determined LV diastolic function including LV-filling index (E/E') by echocardiography. Diastolic function was normal in 21 patients (DD class 0), impaired in 14 patients (DD class 1) and pseudonormal in 6 patients (DD class 2). E/E' increased from DD class 0 to 2 (6.6±1.3 vs. 9.0±2.4 vs. 12.1±6.2; p<0.01). E/E' correlated with the maximal creatine kinase activity during AMI (CKMB(max) r=0.73, p<0.01), the change in end-diastolic or end-systolic LV volumes between AMI and 4months (∆LVEDV r=0.67, p<0.01; ∆LVESV r=0.58, p<0.01), ejection fraction at 5years (r=-0.47, p<0.01) and NT-proBNP serum levels at 5years (r=0.37, p<0.05). Multivariate analysis revealed CKMB(max) (β=0.56, p<0.01) and ∆LVEDV (β=0.38, p<0.01) as independent predictors for E/E' 5years after AMI. Adverse early remodeling processes (reflected by LV dilatation between infarction and 4months) determine long-term diastolic function in patients after reperfused AMI and progenitor cell therapy.