title: Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance.
abstract: BACKGROUND
  The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI.
  
  
  METHODS
  Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV.
  
  
  RESULTS
  The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened).
  
  
  CONCLUSIONS
  The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK. h.bulluck@gmail.com.|The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK. h.bulluck@gmail.com.|National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore. h.bulluck@gmail.com.
authors.forename: Heerajnarain
authors.identifier: http://orcid.org/0000-0002-1985-1783
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
authors.forename: Yun Yun
authors.initials: YY
authors.lastname: Go
authors.affiliation: Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.affiliation: Royal Devon and Exeter Hospital, NHS Foundation Trust, Exeter, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ludman
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rosmini
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Amna
authors.initials: A
authors.lastname: Abdel-Gadir
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Anish N
authors.initials: AN
authors.lastname: Bhuva
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Treibel
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.affiliation: Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy.|Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pica
authors.affiliation: Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.affiliation: The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.|Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, London, UK.|Royal Free Hospital, London, UK.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Herrey
authors.affiliation: The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.|Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Manisty
authors.affiliation: UCL Institute of Nuclear Medicine, University College London Hospital, London, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Groves
authors.affiliation: The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.|Barts Heart Centre, St Bartholomew's Hospital, London, UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK.|The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.|National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.|Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.|Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000368:Aged; D019540:Area Under Curve; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: LV ejection fraction; LV end-diastolic volume; LV end-systolic volume; LV remodeling, trabeculae and papillary muscles; ST-segment elevation myocardial infarction; infarct size, microvascular obstruction