Is cardiac magnetic resonance necessary for prediction of left ventricular remodeling in patients with reperfused ST-segment elevation myocardial infarction?

A Comparison of Three-Dimensional Speckle Tracking Echocardiography Parameters in Predicting Left Ventricular Remodeling

Three-dimensional speckle tracking echocardiography (3D STE) is an emerging noninvasive method for predicting left ventricular remodeling (LVR) after acute myocardial infarction (AMI). Previous studies analyzed the predictive value of 3D STE with traditional models. However, no models that contain comprehensive risk factors were assessed, and there are limited data on the comparison of different 3D STE parameters. In this study, we sought to build a machine learning model for predicting LVR in AMI patients after effective percutaneous coronary intervention (PCI) that contains the majority of the clinical risk factors and compare 3D STE parameters values for LVR prediction. We enrolled 135 first-onset AMI patients (120 males, mean age 54 ± 9 years). All patients went through a 3D STE and a traditional transthoracic echocardiography 24 hours after reperfusion. A second echocardiography was repeated at the three-month follow-up to detect LVR (defined as a 20 percent increase in left ventricular end-diastolic volume). Six models were constructed using 15 risk factors. A receiver operator characteristic curve and four performance measurements were used as evaluation methods. Feature importance was used to compare 3D STE parameters. 26 patients (19.3%) had LVR. Our evaluation showed that RF can best predict LVR with the best AUC of 0.96. 3D GLS was the most valuable 3D STE parameters, followed by GCS, global area strain, and global radial strain (feature importance 0.146, 0.089, 0.087, and 0.069, respectively). To sum up, RF models can accurately predict the LVR after AMI, and 3D GLS was the best 3D STE parameters in predicting the LVR.

Circulating miR-1 as a potential predictor of left ventricular remodeling following acute ST-segment myocardial infarction using cardiac magnetic resonance

Background

The identification of patients with a high likelihood of left ventricular (LV) remodeling with a high-risk prognosis has critical implications for risk stratification after acute ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the relationship between circulating miR-1 and 6-month post-infarct LV remodeling based on cardiac magnetic resonance (CMR) imaging.

Methods

A total of 80 patients with a first STEMI treated with primary percutaneous coronary intervention (PCI) who underwent CMR imaging 1 week and 6 months after STEMI were evaluated. The percentage changes of LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume index (LVESV) at 1 week and 6 months after PCI (%ΔLVEF, %ΔLVEDV and %ΔLVESV) were calculated. miR-1 was measured using polymerase chain reaction (PCR)-based technologies in plasma samples that were collected at admission. The study group was divided into two groups based on a 10% cutoff value for the percentage of change in the LV end-diastolic volume (%ΔLVEDV): remodeling at high risk of major adverse cardiac events (MACEs) (%ΔLVEDV ≥10%, termed the LV remodeling group) and remodeling at lower risk of MACEs (%ΔLVEDV <10%, termed the non-LV remodeling group). The associations of miR-1 expression with the %ΔLVEDV, percentage change in the LV end-systolic volume (%ΔLVESV), and percentage change in the LV ejection fraction at follow-up were estimated.

Results

Twenty-two patients (27.5%) showed adverse LV remodeling, and 58 patients (72.5%) did not show adverse LV remodeling at the 6-month follow-up of CMR. The mean LVEF, LVEDV index, and LVESV index values at 1 week were 50.6%±8.2%, 74.6±12.8 mL/m², and 37.2±10.2 mL/m², respectively. Mean LVEF at follow-up (53.5%±10.6%) was increased compared with baseline (P<0.001). There were significant decreases in LVEDV index and LVESV index values at follow-up (72.0±14.9 mL/m² and 33.7±11.0 mL/m², respectively; P=0.009 and P<0.001, respectively). The expression of miR-1 at admission was positively correlated with the %ΔLVEDV (r=0.611, P<0.001) and %ΔLVESV (r=0.268, P=0.016). Receiver operating characteristic (ROC) analysis showed that miR-1 expression predicted LV remodeling with an area under the curve (AUC) value of 0.68 (95% CI: 0.56-0.78). Compared with the clinical factors of peak creatine kinase-myocardial band (CK-MB) and peak troponin T level, peak logNT-proBNP showed the highest predictive power, with an AUC value of 0.75 (95% CI: 0.64-0.84). A model including the clinical, CMR, and miR-1 factors showed greater predictive power (P=0.034) than a model including only clinical and CMR factors, with AUCs of 0.89 (95% CI: 0.80-0.95) and 0.81 (95% CI: 0.71-0.89), respectively.

Conclusions

Circulating miR-1 at admission is an independent predictor of LV remodeling 6 months after STEMI. miR-1 showed incremental value in predicting LV remodeling compared with the clinical and CMR measurements.