Factors associated with cardiac remodeling in the long-term period in patients with invasive treatment strategy for acute coronary syndrome
Keywords:acute coronary syndrome, myocardial infarction, diastolic dysfunction, heart failure, prognosis, left ventricular remodeling
Background. Heart failure is one of the leading causes of mortality worldwide. Patients with post-infarction remodeling have high risk of developing heart failure. It is important to identify impact factors influencing the risk of cardiac remodeling in the long-term period after acute coronary syndrome (ACS) preventing the progression of ventricular dilation, deterioration of their function and development of heart failure. The purpose: to identify factors associated with cardiac remodeling after ACS in patients with invasive treatment strategy. Materials and methods. The study included 74 patients who were hospitalized with a diagnosis of ACS in 2015. Echocardiography was used to study the dynamics of left ventricular volume and function: end-diastolic index (EDI), end-systolic index (ESI) and ejection fraction (EF) after 1 year. According to the parameters mentioned above, research groups were formed. Types of structural and geometric remodeling were determined according to the principles of A. Ganau. Results. It was determined that the average values of the studied parameters in patients with ACS upon admission and after 1 year had significant differences, such as left atrial enlargement (p = 0.042), increased ESI (p = 0.026) and decreased relative wall thickness (p = 0.042). The frequency of changes in remodeling parameters, which had negative signs depending on ESI, was 40.54 % with EF of 18.9 % and EDI of 24.3 %. Patients of the ESI-1 group had an increase in baseline end-diastolic volume (EDV) (p = 0.00002), end-systolic volume (ESV) (p = 0.00001) and left atrial size (р = 0.0005). In the acute period, patients of the EF-1 group had significantly increased baseline ESV (p = 0.00001), EDV (p = 0.00002); the restrictive type of diastolic dysfunction also prevailed (p = 0.007). Upon admission, number of patients with normal cardiac geometry and concentric hypertrophy prevailed, and 1 year after ACS, the type of remodeling changed to eccentric hypertrophy. Conclusions. ESI and EDI are earlier predictors of post-infarction remodeling compared to the EF. Restrictive type of diastolic dysfunction at admission is associated with the development of maladaptive left ventricular remodeling in 1 year. One year after ACS, the type of remodeling changed to eccentric hypertrophy.
van der Bijl Р., Meda М., Rachid A., Goedemans L., Gersh B.J. Left Ventricular Post-Infarct Remodeling: Implications for Systolic Function Improvement and Outcomes in the Modern Era. JACC: Heart Failure. 2020. Vol. 8. Issue 2. P. 131-140.
Verma А., Meris А., Skali H. et al. Prognostic implications of leftventricular mass and geometry following myocardial infarction: the VALIANT (Valsartanin Acute Myocardial Infarction) Echocardiographic Study. JACC: Cardiovascular Imaging. 2008. Vol. 1. № 5. Р. 582-591. doi: 10.1016/j.jcmg.2008.05.012.
Агеев Ф.Т. Современная концепция диастолической сердечной недостаточности. Кардиоваскулярная терапия и профилактика. 2010. 9(7). С. 97-104.
Nguyen T.L., Phan J., Hogan J., Hee L., Moses D., Otton J., Thomas L. Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction: An important prognostic indicator. American Heart Journal. 2016. 180. P. 117-127. doi:10.1016/j.ahj.2016.05.020.
Гандзюк В.А. Аналіз захворюваності на ішемічну хворобу серця в Україні. Український кардіологічний журнал. 2014. № 3. С. 45-52.
Ganau A., Devereux R.B., Roman M.J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J. Amer. Coll. Cardiology. 1992. Vol. 19. P. 1550-1558.
Fraccarollo D., Galuppo P., Bauersachs J. Novel therapeutic approaches to post-infarction remodelling. Cardiovascular Research. 2012. Vol. 94. Issue 2. P. 293-303. doi: 10.1093/cvr/cvs109.
Hammermeister K.E., DeRouen T.A., Dodge H.T. Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation. 1979. Vol. 59. P. 421-430.
Ponikowski P., Voors A.A., Anker S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016. 37. P. 2129-2200.
Bulluck H., Go Y.Y., Crimi G. et al. Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance. J. Cardiovasc. Magn. Reson. 2017. 19. 26. doi: 10.1186/s12968-017-0343-9. [PMC free article] [PubMed] [CrossRef] [Google Scholar].
Ibanez В., James S., Agewall S. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018. Vol. 39. Issue 2. P. 119-177. URL: https://doi.org/10.1093/eurheartj/ehx393.
Lieb W., Gona Р., Larson M.G. et al. The Natural History of Left Ventricular Geometry in the Community. JACC: Cardiovascular Imaging. 2014. Vol. 7. Issue 9. P. 870-878. doi: 10.1016/ j.jcmg.2014.05.008.
Sharkawi M.A., Kochar А. Heart Failure Prevention Post-Myocardial Infarction: 5 Things to Know. MHS Disclosures. 2020. May 28.
Mentzer G., Hsich E.M. Heart Failure with Reduced Ejection Fraction in Women Epidemiology, Outcomes, and Treatment. Heart Fail. Clin. 2019. Vol. 15(1). P. 19-27. doi: 10.1016/j.hfc.2018.08.003.
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