Ventricular remodeling and heart failure after myocardial infarction: a community

Project: Research project

Project Details


Over the past 2 decades, major changes in the epidemiology of myocardial infarction (MI) have occurred.
Progress in its acute treatment improved short term survival, but heart failure (HF) remains frequent after MI
and leads to excess mortality. Hence, the acute treatment of MI aimed at restoring vessel patency is not
sufficient to prevent HF, underscoring the importance of understanding the contemporary mechanisms leading
to its development. The transition from the initial myocardial injury to ventricular dysfunction and HF is termed
left ventricular remodeling and is characterized by progressive ventricular enlargement, alteration of systolic and
diastolic function and occurrence of mitral regurgitation (MR). Remodeling is a dynamic entity, defined as a
change over time, diagnosed at a stage where deleterious changes cannot be reversed. Hence, it must be
predicted and prevented. Knowledge on cardiac remodeling after MI is incomplete, which hinders its
prevention. Firstly, the exact incidence of remodeling remains to be defined as data pertain mostly to clinical
trials, of uncertain clinical relevance. Secondly, the mechanisms of ventricular remodeling after MI remain to
be defined with the goal of identifying novel predictors that could define targets for prevention and treatment.
Thirdly, most imaging data on remodeling do not reflect state of the art methods or contemporary cohorts.
Thus, addressing the frequency and mechanisms of remodeling after MI is needed to define strategies
to prevent HF and requires relying on clinically relevant populations evaluated by rigorous imaging
techniques integrated with measurements of novel biomarkers. Our 3 specific aims will help elucidate,
within a prospective community cohort, the frequency and mechanisms of ventricular remodeling and the
responsibilities of these mechanisms in the genesis of post MI HF. Aim 1 will measure the frequency and
patterns of left ventricular remodeling after incident MI in a community-based population. Remodeling
will be evaluated by two- and three-dimensional echocardiography and speckle tracking and defined as
changes in systolic or diastolic function and MR. Aim 2 will assess the determinants of remodeling,
including clinical characteristics and novel biomarkers. Aim 3 will test the value of the predictors of
remodeling identified in Aim 2 to predict HF after MI. In Aims 1 and 2, we will recruit 420 patients to obtain
serial two-dimensional and three-dimensional echocardiographic studies. Aim 3 will extend these findings to
the entire population-based MI incidence cohort. Our proposed application comprises several key innovative
aspects. Our ongoing surveillance of coronary disease will provide a strong recruitment platform and a robust
backdrop to optimize the clinical relevance of our data. Rigorous imaging approaches will provide unique
insights into the remodeling process. We will integrate imaging and biomarker data to identify predictors of
remodeling that can be measured at index MI to enable risk prediction of HF in contemporary MI populations.
Effective start/end date1/15/1412/31/17


  • National Institutes of Health: $742,573.00
  • National Institutes of Health: $742,525.00
  • National Institutes of Health: $731,387.00


  • Medicine(all)

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