LAUSR

INTRODUCTION Prediction of adverse outcome following myocardial infarction (MI) remains challenging. We reviewed baseline biomarker and cardiac magnetic resonance (CMR) data to identify predictors of outcome in a cohort of patients enrolled in a clinical trial assessing the effect of eplerenone on left ventricular (LV) remodeling after MI, followed for over 10 years. METHODS AND RESULTS 100 patients (mean age 59yr, 77% male) admitted with MI between 2004-06, LV ejection fraction (LVEF) <40% but no heart failure had a baseline CMR and measurement of N-terminal pro-B-type natriuretic peptide [NT-proBNP], galectin-3 and ST2 prior to 1:1 randomization to placebo:eplerenone, given for 24 weeks. All-cause mortality and the composite of death, nonfatal MI and heart failure hospitalization were recorded over median 9.3 years. 16 (16.0%) patients died during follow-up and 25 (25.0%) suffered the composite outcome. LV volumes, anterior infarct location, infarct subendocardial extent and degree of LV remodeling were higher in those who died but LVEF was similar. Higher concentrations of NT-proBNP (5074 [1238] vs. 2101 [176]ng/L, p<0.001) and galectin-3 (18.0 [2.1] vs. 14.0 [0.5]ng/mL, p=0.007) were seen in non-survivors. Lower left ventricular global function index (LVGFI) was associated with higher NT-proBNP and ST2 levels (p<0.01). Baseline LV end-systolic volume index (LVESVI), end-diastolic volume index (LVEDVI), NT-proBNP, and galectin-3 were univariate predictors of death; LVESVI and NT-proBNP remained significant on multivariate analysis. CONCLUSIONS CMR-derived LV volumes and baseline biomarkers provide additional prognostic information in survivors of MI. LVGFI has potential in identifying patients at high risk of adverse remodeling. This article is protected by copyright. All rights reserved.