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Non-invasive pressure-volume loops provide incremental value to age, sex, and infarct size for predicting adverse cardiac remodelling after ST-elevation myocardial infarction

Lav, Theodor LU ; Engstrøm, Thomas LU ; Kyhl, Kasper ; Nordlund, David LU ; Lønborg, Jacob ; Engblom, Henrik LU ; Erlinge, David LU orcid and Arheden, Håkan LU (2025) In European Heart Journal Imaging Methods & Practice 3(1). p.1-12
Abstract

AIMS: This study aimed to assess the predictive value of non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) for determining development of adverse remodelling 3 months after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

METHODS AND RESULTS: In total, 181 STEMI patients examined with CMR during the index admission (baseline) after primary PCI and at 3-month follow-up in The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3) study were retrospectively analysed. A time-varying elastance model for generating PV loops from CMR volumetry and brachial blood pressure was used to calculate contractility, arterial... (More)

AIMS: This study aimed to assess the predictive value of non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) for determining development of adverse remodelling 3 months after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

METHODS AND RESULTS: In total, 181 STEMI patients examined with CMR during the index admission (baseline) after primary PCI and at 3-month follow-up in The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3) study were retrospectively analysed. A time-varying elastance model for generating PV loops from CMR volumetry and brachial blood pressure was used to calculate contractility, arterial elastance, stroke work, potential energy, efficiency, external power, ventriculoarterial coupling, and energy per ejected volume. Adverse remodelling was seen in 28 patients (15%), defined as a concomitant increase in end-diastolic and end-systolic volume of ≥12% from baseline to follow-up. PV loop variables measured at baseline showed predictive value for adverse remodelling, independent of age, sex, and infarct size (IS) by a logistic regression analysis: contractility [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8-12.4] and efficiency (OR 1.05, 95% CI 1.00-1.11). Furthermore, females showed a higher increase in contractility between the timepoints (ΔContractility = 0.4 ± 0.4 mmHg/mL vs. 0.1 ± 0.4 mmHg/mL, P < 0.0001). A higher energy expenditure was seen at baseline in left arterial descending artery infarctions compared to left circumflex artery and right coronary artery infarctions.

CONCLUSION: Non-invasive PV loop variables by CMR have incremental predictive value to age, sex, and IS for determining development of adverse cardiac remodelling in STEMI patients treated with primary PCI. Furthermore, the PV loop variables show significant differences in post-infarct cardiovascular adaptation between sexes and culprit vessels.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal Imaging Methods & Practice
volume
3
issue
1
article number
qyaf008
pages
1 - 12
publisher
Oxford University Press
external identifiers
  • pmid:39991259
ISSN
2755-9637
DOI
10.1093/ehjimp/qyaf008
language
English
LU publication?
yes
additional info
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
b0ab7cc4-397e-4bef-a7d8-a3e249f6639f
date added to LUP
2025-06-15 23:54:48
date last changed
2025-06-16 07:37:11
@article{b0ab7cc4-397e-4bef-a7d8-a3e249f6639f,
  abstract     = {{<p>AIMS: This study aimed to assess the predictive value of non-invasive pressure-volume (PV) loop variables by cardiovascular magnetic resonance (CMR) for determining development of adverse remodelling 3 months after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).</p><p>METHODS AND RESULTS: In total, 181 STEMI patients examined with CMR during the index admission (baseline) after primary PCI and at 3-month follow-up in The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3) study were retrospectively analysed. A time-varying elastance model for generating PV loops from CMR volumetry and brachial blood pressure was used to calculate contractility, arterial elastance, stroke work, potential energy, efficiency, external power, ventriculoarterial coupling, and energy per ejected volume. Adverse remodelling was seen in 28 patients (15%), defined as a concomitant increase in end-diastolic and end-systolic volume of ≥12% from baseline to follow-up. PV loop variables measured at baseline showed predictive value for adverse remodelling, independent of age, sex, and infarct size (IS) by a logistic regression analysis: contractility [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8-12.4] and efficiency (OR 1.05, 95% CI 1.00-1.11). Furthermore, females showed a higher increase in contractility between the timepoints (ΔContractility = 0.4 ± 0.4 mmHg/mL vs. 0.1 ± 0.4 mmHg/mL, P &lt; 0.0001). A higher energy expenditure was seen at baseline in left arterial descending artery infarctions compared to left circumflex artery and right coronary artery infarctions.</p><p>CONCLUSION: Non-invasive PV loop variables by CMR have incremental predictive value to age, sex, and IS for determining development of adverse cardiac remodelling in STEMI patients treated with primary PCI. Furthermore, the PV loop variables show significant differences in post-infarct cardiovascular adaptation between sexes and culprit vessels.</p>}},
  author       = {{Lav, Theodor and Engstrøm, Thomas and Kyhl, Kasper and Nordlund, David and Lønborg, Jacob and Engblom, Henrik and Erlinge, David and Arheden, Håkan}},
  issn         = {{2755-9637}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--12}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Imaging Methods & Practice}},
  title        = {{Non-invasive pressure-volume loops provide incremental value to age, sex, and infarct size for predicting adverse cardiac remodelling after ST-elevation myocardial infarction}},
  url          = {{http://dx.doi.org/10.1093/ehjimp/qyaf008}},
  doi          = {{10.1093/ehjimp/qyaf008}},
  volume       = {{3}},
  year         = {{2025}},
}