Multifactorial model for predicting adverse post-infarction left ventricular remodeling, including left ventricular–arterial coupling

Objective: to obtain the early predictors and predictive model for adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction.

Material and methods: the study included 141 patients with primary ST-segment elevation myocardial infarction. A comprehensive clinical, laboratory, and instrumental examination was carried out on days 7–9 from the disease onset, and in 24 and 48 weeks of follow-up with full pharmacotherapy preservation.

Results: the follow-up was completed in 125 (88.7%) patients. They were divided into two groups according to the results of echocardiography: the group with adverse left ventricular remodeling (n = 63) (an increase of end-diastolic volume index >20% and (or) end-systolic volume index >15% in 24 week in comparison with days 7–9 examination) and the group of slowly progressive left ventricular remodeling (n = 62). The frequency of adverse outcomes (repeated myocardial infarction, unstable angina, hospitalization for heart failure decompensation, ventricular arrhythmias, cardiac surgery) during 48 weeks of follow-up was 30.2% (19 patients) in the group of adverse left ventricular remodeling and 4.8% (3 patients) in the group of slowly progressive left ventricular remodeling. The odds ratio for adverse outcome was 8.5 (95% confidence interval – 2.4–30.5) (P = 0.001). According to the results of univariate regression analysis, the risk factors for adverse left ventricular remodeling were: waist circumference, brain natriuretic peptide, end-systolic volume index, left ventricular ejection fraction, end-systolic left ventricular elastance, including normalized to body surface area, left ventricular–arterial coupling index, local systolic pressure in the common carotid arteries. The predictive model including a waist circumference, value of brain natriuretic peptide, and left ventricular–arterial coupling index was developed according to the results of multivariate analysis.

Conclusion: the developed predictive model for various types of left ventricular remodeling after ST-segment elevation myocardial infarction is useful for risk stratification.

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