Features of the course of the postinfarction period in patients with adverse left ventricular remodeling

Background. Adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI) is associated with the high risk of complications. Objective. Identification of laboratory parameters, structural and functional characteristics of arteries associated with ALVR after STEMI and revascularization. Design and methods. 141 patients were included. On days 7–9, after 24–48 weeks, an examination was performed. The endpoints were recorded for 192 weeks. Results. 125 patients were followed up, who were divided into groups: 1st “ALVR” — 63 patients with an increase in end-diastolic volume index by > 20 % and/ or end-systolic volume index by > 15 %; 2nd group “Without ALVR” — 62 people. After 48 weeks, in the 1st group, in patients with glomerular filtration rate (eGFR) < 90 ml/min/1.73 m², the indicator increased by 12.2 %; in individuals with an initial eGFR ≥ 90 ml/min/1.73 m², it decreased by 18.7 %. In patients without ALVR and initial eGFR < 90 ml/min/1.73 m², the indicator increased by 6.2 %. Only in group 2, positive dynamics of endothelial function indicators was revealed. The odds ratio of adverse events in group 1 was 2.8 [1.3–6.1] compared with group 2 (p = 0.007). Conclusion. The development of ALVR after MI in the medium term was characterized by a deterioration in the filtration capacity of the kidneys and persistent endothelial dysfunction over 48 weeks, a high incidence of adverse events over 192 weeks.

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