Role of aldosterone in the mid- and long-term left ventricular remodelling after acute myocardial infarction: the REMI study.

Abstract

Whether aldosterone levels after myocardial infarction (MI) are associated with medium and long-term left ventricular (LV) remodelling in the era of systematic use of renin-angiotensin system inhibitors is uncertain. We prospectively investigated the relationship between aldosterone levels and mid- and long-term LV remodelling in patients with acute MI. AND RESULTS: Plasma aldosterone was measured in 119 patients successfully treated by primary percutaneous coronary angioplasty for a first acute ST-elevated MI (STEMI) 2-4 days after the acute event. LV volumes were assessed by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) in the same timeframe and 6 months later. LV assessment was repeated by TTE 3-9 years after MI (N=80). The median aldosterone level at baseline was 23.1 [16.8; 33.1] pg/mL. Higher post-MI aldosterone concentration was significantly associated in multivariable model with more pronounced increase in LV end-diastolic volume index (TTE: β ± SE: 0.113 ± 0.046, P =0.015; CMR: β ± SE: 0.098 ± 0.040, P =0.015) and LV end-systolic volume index (TTE: β ± SE: 0.083 ± 0.030, P=0.008; CMR: β ± SE: 0.064 ± 0.032, P =0.048) at 6-month follow-up, regardless of the method of assessment. This result was consistent also in patient with a LV ejection fraction (LVEF) >40%. The association between baseline plasma aldosterone and adverse LV remodelling did not persist at the 3-9 years follow-up evaluation. Aldosterone concentration in the acute phase was associated with adverse LV remodelling in the mid-term, even in the subgroup of patients with LVEF >40%, suggesting a potential role of the mineralocorticoid system in post-MI adverse remodelling. Plasma aldosterone was no longer associated with LV remodelling in the long-term. (NCT01109225) This article is protected by copyright. All rights reserved.