Predictive value of early cardiac mri functional and geometric indexes on adverse left ventricular remodelling in anterior STEMI patients. A report from the CIRCUS study

Abstract

Post-infarction adverse left ventricular (LV) remodelling is strongly associated with subsequent heart failure events. The conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR). The aim of our study was to assess their predictive value on one-year adverse LV remodelling in patients with anterior myocardial infarction. CMR studies were performed in 129 anterior ST-elevated myocardial infarction (STEMI) patients (58 ± 12 years, 78%men) from the randomized CIRCUS trial (CMR sub-study) treated with the primary percutaneous coronary intervention (PCI) and were followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). The conicity index, sphericity index, LVGFI, infarct size (IS) and microvascular obstruction (MVO) were assessed by CMR performed 5 ± 2 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume ≥ 15% by transthoracic echocardiography at 1 year. Adverse LV remodeling occurred in 27% of patients in one year. IS and MVO were significantly predictive of adverse LV remodelling (OR = 1.03, CI 95% [1.02–1.05], P < 0.001 and OR = 1.12, CI 95% [1.05–1.22] P < 0.001, respectively). Among the newly tested indexes, only LVGFI was significantly predictive of adverse LV remodelling (OR = 1.10, CI 95% [1.03–1.16], P = 0.001). In multivariate analysis, only IS remained an independent predictor of adverse LV remodeling at 1 year (OR = 1.05, CI 95% [1.02–1.08], P < 0.001). LVGFI and IS were associated with the occurrence of MACE (OR = 1.21; CI 95% [1.08–1.37], P < 0.001 and OR = 1.02; CI 95% [1.00–1.04], P = 0.018 respectively). However, the conicity and sphericity indexes were not associated with MACE ( Fig. 1 ). LVGFI was associated with adverse LV remodelling and MACE at one year after anterior STEMI. However, this relationship and its predictive value in on top of infarct size remain hypothesis-generating at this stage. Further studies are needed to explore the relationship of all these remodelling indices with adverse outcomes in larger populations of MI patients.