White blood cell and peripheral blood mononuclear cell counts for the prediction of left ventricular remodeling after myocardial infarction

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

As cardiac magnetic resonance imaging (CMR) has become widely used for evaluation of myocardial viability after acute myocardial infarction, the additional value of CMR parameters for prediction of left ventricle (LV) remodeling has been receiving interest. The aim of the study was to investigate the additional predictive value of CMR parameters for LV remodeling after successful reperfusion of ST-segment elevation myocardial infarction (STEMI) using multiple predictive models. LV remodeling was defined as ≥20% increase in end-diastolic volume at 6 month follow-up echocardiography. Using multiple stepwise regression analysis, conventional risk model was classified as following; model 1 (clinical factors), model 2 (model 1 + angiographic factors), model 3 (model 2 + echocardiographic factors) and CMR-added model; model 4 (model 3 + CMR factors). Among 262 enrolled patients, 25.1% showed LV remodeling. There were significant increments of c-statistics from the predictive model 1 to model 3 (AUC; 0.675 [0.60-0.75], 0.708 [0.64-0.78], 0.756 [0.69-0.82], respectively. all p < 0.05). However, model 4, which added the CMR variables, did not show any increase in predictive value compared with model 3 (AUC; 0.763 [0.70-0.83] versus 0.756 [0.69-0.82], p = 0.11). During the 28.2 months of median follow up, the incidence of hospitalization for heart failure was significantly higher in the patients with LV remodeling (6.1% vs. 0.5%, p = 0.02). CMR parameters did not provide incremental predictive value above the assessment by conventional echocardiography-based risk model in patients with STEMI.

Usefulness of circulating biomarkers for the prediction of left ventricular remodeling after myocardial infarction

Left ventricular (LV) remodeling after myocardial infarction (MI) indicates a high risk of heart failure and death, but LV remodeling remains difficult to predict. Biomarkers may help to refine risk stratification for a more personalized medical approach. They may also shed light on the pathophysiologic processes involved. We performed a systematic review of the published evidence about the association of circulating biomarkers with LV remodeling after MI. We selected 59 publications. Overall, these studies examined 112 relations between 52 different biomarkers and LV remodeling. The biomarkers most consistently associated with LV remodeling were involved in extracellular matrix turnover or neurohormonal activation: matrix metalloproteinase-9, collagen peptides, and B-type natriuretic peptide. This review underscores the vitality of the research on LV remodeling but concludes that the ideal biomarker has not yet been identified. To reach this goal, future studies will have to be larger, have standardized imaging end points, and include replication populations to define optimal cutoffs for LV remodeling prediction. Cardiovascular magnetic resonance appears to be the best technique for LV remodeling assessment but its current availability may be a concern for recruitment for multicenter studies. Recent technologic advances will probably yield new candidate biomarkers of LV remodeling. Tests are necessary to determine whether a multimarker approach would significantly improve risk prediction.

Circulating levels of soluble Fas ligand and left ventricular remodeling after acute myocardial infarction (from the REVE-2 study)

BACKGROUND

Apoptosis-related molecules may contribute to left ventricular (LV) remodeling after myocardial infarction (MI). To validate this hypothesis, we evaluated the relation between circulating plasma levels of soluble Fas ligand (sFas-L) and LV remodeling in patients post-MI.

METHODS AND RESULTS

This prospective multicenter study included 246 patients with a first anterior Q-wave MI. Serial echocardiographic studies were performed at hospital discharge and 3 and 12 months after MI; quantitative analysis was performed at a core echocardiography laboratory. Clinical follow-up was performed at 3 years post-MI. Blood samples to measure sFas-L were obtained at 1 month after MI. Median sFas-L level was 50.2 pg/mL. During the 1 year follow-up, LV remodeling was documented by a significant increase in LV volumes. LV end-diastolic and end-systolic volumes at baseline, 3 months, and 12 months after MI did not differ according to sFas-L levels; changes in LV volumes were not associated with sFas-L levels. By multivariate analysis, 2 variables were independently associated with LV remodeling: B-type natriuretic peptide (BNP) (p=0.008) and baseline ejection fraction (p=0.02). sFas-L levels were not associated with cardiovascular death or rehospitalization for heart failure at 3 years; conversely, high levels of BNP were associated with worse clinical outcome.

CONCLUSIONS

Soluble Fas-L levels are not associated with LV remodeling after MI. Further research is needed to identify apoptotic markers that may be associated with outcome post-MI.