Prediction of 6 months left ventricular dilatation after myocardial infarction in relation to cardiac morbidity and mortality. Application of a new dilatation model to GISSI-3 data.
OBJECTIVE
To predict the long-term left ventricular volume index early after myocardial infarction and to investigate the relationship between long-term left ventricular dilatation risk and clinical outcome.


RESULTS
By applying a previously developed dilatation model, we predicted the 6-month left ventricular volume index early after myocardial infarction (median 9 days) in 13,679 GISSI-3 patients, to identify patients at high risk of long-term left ventricular dilatation. The left ventricular systolic and diastolic volume indexes at 6 months were predicted with r=0.72 and r=0.68, respectively, in the subgroup of patients in whom a pre-discharge echo was available (n=7842). Patients predicted to be at risk for long-term left ventricular dilatation had an increased risk of mortality (RR 1.87, 95% CI: 1.48 to 2.36) and heart failure at 6 months (RR 2.59, 95% CI:2.04 to 3.28), but no increased risk of reinfarction at 6 months (RR 1.12, 95% CI: 0.87 to 1.45) or of angina pectoris (RR 1.07, 95% CI: 0.95 to 1.20).


CONCLUSIONS
Our prediction of long-term left ventricular dilatation, obtained by applying our new dilatation model in over 13,000 GISSI-3 patients, correlated well with mortality and heart failure after myocardial infarction. Therefore, our new dilatation model may contribute to more efficient risk stratification early after myocardial infarction.
de Kam
P J
PJ
University Hospital Groningen, The Netherlands.
Nicolosi
G L
GL
Voors
A A
AA
van den Berg
M P
MP
Brouwer
J
J
van Veldhuisen
D J
DJ
Barlera
S
S
Maggioni
A P
AP
Giannuzzi
P
P
Temporelli
P L
PL
Latini
R
R
van Gilst
W H
WH
D004108:Dilatation, Pathologic; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology*