The Predictors Of Left Ventricular Reverse Remodeling In Patients With Reduced Ejection Fraction Heart Failure After ST-segment Elevation Myocardial Infarction

Objective:To analyze the related predicting factors of left ventricular reverse remodeling(LVRR)in patients with reduced ejection fraction heart failure(HFrEF)after ST-segment elevation myocardial infarction(STEMI).At the same time,the predicting value of relevant predictors on LVRR were explored.Methods:From January 2018 to December 2020,the First Affiliated Hospital of Zhengzhou University continuously collected all patients diagnosed with STEMI who received direct percutaneous coronary intervention within 12 hours,and the left ventricular ejection fraction measured by echocardiography within 3 days after primary PCI was less than 40%.LVEF was measured by echocardiography within three days after PPCI operation.After admission,the patients were given dual antiplatelet medicine load and anticoagulation therapy.The operation approach was to insert the arterial sheath through the radial artery or femoral artery.The experienced cardiovascular interventional physician performed coronary angiography to detect culprit vessel and the stenosis degree of other coronary artery,and the model and quantity of drug eluting stent were selected according to the coronary calcification,coronary diameter and stenosis.According to the patients’physical status,it is decided to treat the remaining coronary leisions directly or selectively.Aspirin and P2Y12 inhibitor were taken routinely after PPCI,while the use of beta adrenergic receptor blocker,ACEI/ARB/ARNI,MRA,diuretic,SGLT-2i were depended on the condition of patients.Echocardiography results of all patients were followed up six months after PCI,the absolute value of LVEF increased by≥10%and LVEF≥50%compared with the baseline,and the absolute value of LVEDd decreased by≥10%and LVEDd≤55mm from baseline was LVRR group,on the contrary,it was NLVRR group.The clinical data of enrolled patients was recorded including baseline data,age,sex,previous medical history,heart rate,blood pressure,Killip grade,general biochemical indicators,echocardiographic indicators,operation related data and medicine through the electronic medical record system.Biplane Simpson’s method was used to measure LVEDV,LVESV,LVEF and FS in echocardiography.Using the statistical software of SPSS 26.0 to compare whether the differences in examination indexes between two groups were statistically significantm,and statistical factors were included in multivariate Logistic regression analysis to determine the predictors of left ventricular reverse remodeling in patients with STEMI and HFrEF.The ROC curve was drawn by MedCalc 19.0,and the area under ROC curve(AUC)between the two indexes was compared by Delong test.P<0.05 was considered to be a statistically significant difference.Results:1.The total number of patients included in this study is 108,including 48 patients in the LVRR group and 60 patients in the NLVRR group.Comparison of general data between the LVRR group and the NLVRR group,there were no significant differences in age,BMI,gender,myocardial infarction history,PCI story,stroke history,hypertension,diabetes,smoking history,drinking history,blood pressure,heart rate and dual antiplatelet medicine scheme between two groups(P>0.05).In conventional biochemical indicators,there were no statistically significant differences between the two groups of patients in creatinine,eGFR,creatine kinase-MB peak,albumin,TC,LDL-C,HDL-C,TG,WBC,Hb,PLT,RDW,glycosylated hemoglobin,FPG and LVEF(P>0.05).The levels of peak NT-proBNP,peak cTnT,IBil,LVEDV and LVESV in NLVRR group were higher than those of LVRR group,while FS was lower than that of LVRR group,and the differences were statistically significant(P<0.05).2.The operational data of LVRR group and NLVRR group were compared,there were no significant differences between the two groups in operational artery approach,culprit vessel,TIMI flow,multiple lesions,number of implanted culprit vascular stents,thrombus aspiration,intracoronary sodium nitroprusside,intracoronary tirofiban,intracoronary prourokinase,temporary pacemaker implantation,IABP implantation and ECMO implantation(P>0.05).The proportion of complete revascularization in LVRR group was significantly higher than that of NLVRR group(P<0.05),and the total ischemic time in LVRR group was significantly lower than that of NLVRR group(P<0.05).3.Comparing the discharged medications of the two groups,there were no statistically significant differences in the drug use of aspirin,P2Y12 inhibitor,statins,beta adrenergic receptor blockers,ivabradines,ACEI/ARB/ARNI,MRA,diuretics,digoxins,SGLT-2i between LVRR group and NLVRR group(P>0.05).4.All single factors with statistical significance in clinical data were screened out(P<0.05)and included in multivariate Logistic regression model for multivariate analysis,including total ischemic time(TIT),LVEDV,LVESV,FS,complete revascularization,peak NT-proBNP,peak cTnT,IBil.Multiple collinearity diagnosis was performed for the above risk factors and the collinearity factors were removed,so remove the influencing factor of LVESV.The rest of risk factors were included in the multivariate Logistic regression analysis,and the results showed that the independent influencing factors of LVRR in STEMI patients with HFrEF were TIT,peak cTnT,and complete revascularization,of which TIT and peak cTnT were risk factors,and total revascularization was protective factor.5.Logistic regression equation was used to calculate the predictive value of TIT,peak cTnT and their joint detection,and drawed the ROC curve of these three factors to predict LVRR in STEMI patients.Through the analysis of ROC curve,it could convey a discovery that TIT,peak cTnT and the combination of two all had predictive value for LVRR(P<0.05).The AUC of LVRR predicted by TIT was 0.737,the best cut-off value was 276.5,the sensitivity was 76.67%and the specificity was 70.83%.The AUC of peak cTnT predicted LVRR was 0.714,the best cut-off value was 3.203,the sensitivity was 65%and the specificity was 72.92%.The AUC of LVRR predicted by TIT combined with peak cTnT was 0.817,which was higher than that predicted by TIT and peak cTnT alone,and the difference was statistically significant(P<0.05).Conclusions:1.The independent predictors of LVRR in STEMI patients with HFrEF are total ischemic time,peak cTnT and complete revascularization,of which total ischemic time and peak cTnT are risk factors,and total revascularization is protective factor.2.Total ischemia time and cTnT peak value have certain predictive value for LVRR of STEMI patients with HFrEF.The predictive value of total ischemic time combined with cTnT peak is higher than that of total ischemic time and cTnT peak alone.This has certain clinical significance for early detection of risk factors and improvement of cardiac function in STEMI patients.