title: Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction: An important prognostic indicator.
abstract: We sought to determine the relationship of adverse diastolic remodeling (ie, worsening diastolic or persistent restrictive filling) with infarct scar characteristics, and to evaluate its prognostic value after ST-segment elevation myocardial infarction (STEMI).
  
  
  
  Severe diastolic dysfunction (restrictive filling) has known prognostic value post STEMI. However, ongoing left ventricular (LV) remodeling post STEMI may alter diastolic function even if less severe.
  
  
  
  There were 218 prospectively recruited STEMI patients with serial echocardiograms (transthoracic echocardiography) and cardiac magnetic resonance imaging (CMR) performed, at a median of 4 days (early) and 55 days (follow-up). LV ejection fraction and infarct characteristics were assessed by CMR, and comprehensive diastolic function assessment including a diastolic grade was evaluated on transthoracic echocardiography. 'Adverse diastolic remodeling' occurred if diastolic function grade either worsened (≥1 grade) between early and follow-up imaging, or remained as persistent restrictive filling at follow-up. Follow-up infarct scar size (IS) predicted adverse diastolic remodeling (area under the curve 0.86) and persistent restrictive filling (area under the curve 0.89). The primary endpoint of major adverse cardiovascular events (MACE) occurred in 48 patients during follow-up (mean, 710±79 days). Kaplan-Meier analysis showed that adverse diastolic remodeling (n=50) and persistent restrictive filling alone (n=33) were significant predictors of MACE (both P<.001). Multivariate Cox analysis, when adjusted for TIMI risk score and CMR IS, microvascular obstruction, and LV ejection fraction, showed adverse diastolic remodeling (HR 3.79, P<.001) was an independent predictor of MACE, as was persistent restrictive filling alone (HR 2.61, P=.019).
  
  
  
  Larger IS is associated with adverse diastolic remodeling. Following STEMI, adverse diastolic remodeling is a powerful prognostic marker, and identifies a larger group of 'at-risk' patients, than does persistent restrictive filling alone.
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Tuan L
authors.initials: TL
authors.lastname: Nguyen
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Phan
authors.affiliation: South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Jarred
authors.initials: J
authors.lastname: Hogan
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Leia
authors.initials: L
authors.lastname: Hee
authors.affiliation: Radiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Moses
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Otton
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Upul
authors.initials: U
authors.lastname: Premawardhana
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Rajaratnam
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: Hany
authors.initials: H
authors.lastname: Dimitri
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Richards
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, The University of NSW, Sydney, NSW, Australia. Electronic address: nguyenletuan@hotmail.com.
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
mesh_terms: D003971:Diastole; D004452:Echocardiography; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D020257:Ventricular Remodeling / Q000502:physiology*