title: Prognostic value of reverse left ventricular remodeling after primary angioplasty for STEMI.
abstract: OBJECTIVE
  Thus far, the prognostic value of reverse left ventricular (LV) remodeling after ST-elevation acute myocardial infarction (STEMI) has not been fully evaluated. We sought to investigate the incidence, major determinants, and long-term clinical significance of reverse LV remodeling in a large series of STEMI patients successfully treated with primary percutaneous coronary intervention (P-PCI).
  
  
  RESULTS
  Serial complete 2D-echocardiograms were obtained within 24h after P-PCI, and at 1 and 6 months in 512 consecutive reperfused STEMI patients. Reverse remodeling was defined as a reduction >10% in LV end-systolic volume (LVESV) at 6 month follow-up. Reverse LV remodeling occurred in 49% of study population. At follow-up (41.6±23 months), late heart failure (HF) rate was significantly higher among patients without reverse LV remodeling as compared with those with it (32% vs. 11%, P<0.0001). At multivariate analysis, independent predictors of reverse LV remodeling were a small infarct size measured as peak creatine kinase value (P<0.0001), a small functional myocardial damage measured as wall motion score index within the infarct zone (P=0.018) and baseline LVESV (P<0.0001). After adjustment for several clinical, echographic and angiographic variables, Cox analysis identified reverse LV remodeling as the only beneficial independent predictor of long-term heart failure-free survival (HR: 0.44, 95% CI: 0.275-0.722).
  
  
  CONCLUSIONS
  Reverse LV remodeling occurred in half of successfully reperfused STEMI patients. Small structural and functional myocardial damages within the infarct zone are the major determinants of reverse LV remodeling. As expression of effective myocardial salvage by P-PCI, the reverse remodeling is an important predictor of favorable long-term outcome.
authors.affiliation: Department of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bellandi
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D020257:Ventricular Remodeling / Q000502:physiology*