Abstract
Background: Limited data is available on the potential value of estimated cardiovascular event risk for prediction of left ventricular (LV) remodeling and size of infarcted tissue after ST-elevation myocardial infarction (STEMI). Methods: Therefore, we assessed in a consecutive series of patients with first STEMI, successful primary percutaneous coronary intervention (PCI), and single-vessel disease the potential relationship between the Framingham Risk Score and parameters of both LV remodeling and infarct tissue characteristics, as determined with contrast-enhanced (CE) cardiovascular magnetic resonance (CMR) 6 months after the index event. Parameters of LV remodeling were end-diastolic and end-systolic volumes, ejection fraction, and wall motion score index; infarct tissue characteristics comprised core, peri, and total infarct size, and transmural extent. Results: A total of 25 patients (21 men, 56 ± 10 years) were studied, and the mean Framingham Risk Score was 14.1 ± 5.8%. There was a significant relation between Framingham Risk Score and multiple parameters of LV remodeling: LV ejection fraction, end-diastolic volume, end-systolic volume, and wall motion score index after 6 months (r=-0.55-0.76; p=0.000 for all). Framingham Risk Score showed no relation with various infarct tissue characteristics (ns). Male gender was the only component of the Framingham Risk Score that correlated individually with a few parameters of LV remodeling: LV end-diastolic volume and end-systolic volume (p=0.000 for both). Conclusion: In a series of consecutive patients with first STEMI, successful primary PCI, and single-vessel coronary artery disease, we observed a significant relation between the Framingham Risk Score and several CMRbased parameters of LV remodeling. The results of our small hypothesis-generating study underline the supremacy of multifactorial risk scores as tools for prediction of unfavorable cardiovascular outcome. Additionally, the data support the hypothesis that there might be a future role for a novel and specific multifactorial risk score in predicting unfavorable LV remodeling, which finally could trigger risk-adjusted preventive measures.
Highlights
Major determinants of poor outcome following ST-elevation myocardial infarction (STEMI) are, left ventricular (LV) remodeling, as well as size, location, transmurality, and heterogeneity of the infarcted tissue as assessed bypathologic analyses [1,2]
Patients met the following inclusion criteria: (1) STEMI with successful early revascularization within 12 hours after the start of symptoms and TIMI 3 flow at the end of the procedure, defined as complete perfusion, (2) single-vessel disease at coronary angiogram, (3) complete contrast enhancement (CE)-cardiovascular magnetic resonance (CMR) data available 6 months after STEMI
Current smoking showed a significant relation with transmural extent of scar (p=0.04, Table 2). In this relatively small but homogeneous series of consecutive patients with first STEMI, successful primary percutaneous coronary intervention (PCI), and single-vessel coronary artery disease, we observed a significant relation between the Framingham Risk Score and several parameters of LV remodeling as assessed with CE-CMR six months after the event
Summary
Major determinants of poor outcome following ST-elevation myocardial infarction (STEMI) are, left ventricular (LV) remodeling, as well as size, location, transmurality, and heterogeneity of the infarcted tissue as assessed by (histo)pathologic analyses [1,2]. Chronic medical therapy has been shown to reduce the extent of LV remodeling during follow-up [4,5,6] Both LV remodeling and infarct tissue characteristics can be assessed with cardiovascular magnetic resonance (CMR) imaging in combination with the contrast enhancement (CE) technique [7,8,9,10]. There is no such thing as a “single cause” of LV remodeling, which can even be observed following successful revascularization procedures. Limited data is available on the potential value of estimated cardiovascular event risk for prediction of left ventricular (LV) remodeling and size of infarcted tissue after ST-elevation myocardial infarction (STEMI)
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