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Original research article
Long-term left ventricular remodelling after revascularisation for ST-segment elevation myocardial infarction as assessed by cardiac magnetic resonance imaging
  1. Mariella ECJ Hassell1,
  2. Wieneke Vlastra1,
  3. Lourens Robbers2,3,
  4. Alexander Hirsch1,
  5. Robin Nijveldt3,
  6. Jan GP Tijssen1,
  7. Albert C van Rossum3,
  8. Felix Zijlstra4,
  9. Jan J Piek1 and
  10. Ronak Delewi1,2
  1. 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  3. 3Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Ronak Delewi; r.delewi{at}amc.uva.nl

Abstract

Objective Left ventricular remodelling following a ST-segment elevated myocardial infarction (STEMI) is an adaptive response to maintain the cardiac output despite myocardial tissue loss. Limited studies have evaluated long term ventricular function using cardiac magnetic resonance imaging (CMR) after STEMI.

Methods Study population consisted of 155 primary percutaneous coronary intervention treated first STEMI patients. CMR was performed at 4±2 days, 4 months and 24 months follow-up. Patients were treated with beta-blockers, ACE-inhibitors or AT-II- inhibitors, statins and dual antiplatelet according to current international guidelines.

Results Mean left ventricular ejection fraction (LVEF) at baseline was 44%±8%. Twenty-one per cent of the study population had an increase of more than 5.0% after 4 months of follow-up and 21% of the cohort had a decrease of more than 5.0%. Patients with long-term LVEF deterioration have significantly larger end-systolic volumes than patients with improvement of LVEF (61±23 mL/m2 compared with 52±21 mL/m2, p=0.02) and less wall thickening in the remote zone. Patients with LVEF improvement had significantly greater improvement in wall thickening in the infarct areas and in the non-infarct or remote zone.

Conclusion Contrary to previous studies, we demonstrate that myocardial remodelling after STEMI is a long-term process. Long-term LVEF deterioration is characterised by an increase in end-systolic volume and less wall thickening in the remote zones. Patients with LVEF improvement exhibit an increase in left ventricular wall thickening both in the infarct as well as in the remote zones.

Trial registration The HEBE study is registered in The Netherlands Trial Register #NTR166 (www.trialregister.nl) and the International Standard Randomised Controlled Trial, #ISRCTN95796863 (https://c-d-qn9pqajji.sec.amc.nl).

  • cardiac remodelling
  • MRI
  • STEMI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors have contributed to the contents of the submitted manuscript. They read the final manuscript and agree with its submission.

  • Funding This work was supported by a grant by the Dutch Heart Foundation. (Grant number NHS-2011T022) and the National Health Insurance Board/ZON MW (grant number 40-00703-98-11629) to RD.

  • Competing interests None declared.

  • Ethics approval Academic Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.