Prediction of Reverse Remodeling at Cardiac MR Imaging Soon after First ST-Segment-Elevation Myocardial Infarction: Results of a Large Prospective Registry.
OBJECTIVE
To assess predictors of reverse remodeling by using cardiac magnetic resonance (MR) imaging soon after ST-segment-elevation myocardial infarction (STEMI).


METHODS
Written informed consent was obtained from all patients, and the study protocol was approved by the institutional committee on human research, ensuring that it conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Five hundred seven patients (mean age, 58 years; age range, 24-89 years) with a first STEMI were prospectively studied. Infarct size and microvascular obstruction (MVO) were quantified at late gadolinium-enhanced imaging. Reverse remodeling was defined as a decrease in left ventricular (LV) end-systolic volume index (LVESVI) of more than 10% from 1 week to 6 months after STEMI. For statistical analysis, a simple (from a clinical perspective) multiple regression model preanalyzing infarct size and MVO were applied via univariate receiver operating characteristic techniques.


RESULTS
Patients with reverse remodeling (n = 211, 42%) had a lesser extent (percentage of LV mass) of 1-week infarct size (mean ± standard deviation: 18% ± 13 vs 23% ± 14) and MVO (median, 0% vs 0%; interquartile range, 0%-1% vs 0%-4%) than those without reverse remodeling (n = 296, 58%) (P < .001 in pairwise comparisons). The independent predictors of reverse remodeling were infarct size (odds ratio, 0.98; 95% confidence interval [CI]: 0.97, 0.99; P = .04) and MVO (odds ratio, 0.92; 95% CI: 0.86, 0.99; P = .03). Once infarct size and MVO were dichotomized by using univariate receiver operating characteristic techniques, the only independent predictor of reverse remodeling was the presence of simultaneous nonextensive infarct-size MVO (infarct size < 30% of LV mass and MVO < 2.5% of LV mass) (odds ratio, 3.2; 95% CI: 1.8, 5.7; P < .001).


CONCLUSIONS
Assessment of infarct size and MVO with cardiac MR imaging soon after STEMI enables one to make a decision in the prediction of reverse remodeling.
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Vicente
V
Bodi
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Jose V
JV
Monmeneu
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Jose T
JT
Ortiz-Perez
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Maria P
MP
Lopez-Lereu
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Clara
C
Bonanad
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Oliver
O
Husser
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Gemma
G
Minana
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Cristina
C
Gomez
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Julio
J
Nunez
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Maria J
MJ
Forteza
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Arantxa
A
Hervas
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Elena
E
de Dios
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
David
D
Moratal
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Xavier
X
Bosch
From the Department of Cardiology, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Avenida Blasco Ibañez 17, 46010 Valencia, Spain (V.B., C.B., G.M., C.G., J.N., M.J.F., A.H., E.d.D., F.J.C.); ERESA, Valencia, Spain (J.V.M., M.P.L.L.); Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain (J.T.O.P., X.B.); Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (O.H.); and Center for Biomaterials and Tissue Engineering, Universidad Politécnica de Valencia, Valencia, Spain (D.M.).
Francisco J
FJ
Chorro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D009687:Nuclear Proteins; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D015534:Trans-Activators; D020257:Ventricular Remodeling
D003287:Contrast Media; D009687:Nuclear Proteins; C452851:RSF1 protein, human; D015534:Trans-Activators