Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty
<b>Background</b>: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on s...
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MDPI AG
2025-07-01
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| author | Bogdan-Flaviu Buz Sergiu-Florin Arnautu Mirela-Cleopatra Tomescu Minodora Andor Simina Crisan Dan Gaita Cristina Vacarescu Constantin-Tudor Luca Cristian Mornos Dragos Cozma Diana-Aurora Arnăutu |
| author_facet | Bogdan-Flaviu Buz Sergiu-Florin Arnautu Mirela-Cleopatra Tomescu Minodora Andor Simina Crisan Dan Gaita Cristina Vacarescu Constantin-Tudor Luca Cristian Mornos Dragos Cozma Diana-Aurora Arnăutu |
| author_sort | Bogdan-Flaviu Buz |
| collection | DOAJ |
| description | <b>Background</b>: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. <b>Methods</b>: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14–22 months), including major adverse cardiac events (MACEs). Kaplan–Meier and Cox regression analyses were performed. <b>Results</b>: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, <i>p</i> = 0.04). Male sex (OR 0.30; 95% CI: 0.14–0.65; <i>p</i> < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45–1.85; <i>p</i> < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, <i>p</i> < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181–0.557; <i>p</i> < 0.0001). <b>Conclusions</b>: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women. |
| format | Article |
| id | doaj-art-464b735b1a64440d923d08f5bcafddf2 |
| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
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| series | Biomedicines |
| spelling | doaj-art-464b735b1a64440d923d08f5bcafddf22025-08-20T04:00:50ZengMDPI AGBiomedicines2227-90592025-07-01137178210.3390/biomedicines13071782Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary AngioplastyBogdan-Flaviu Buz0Sergiu-Florin Arnautu1Mirela-Cleopatra Tomescu2Minodora Andor3Simina Crisan4Dan Gaita5Cristina Vacarescu6Constantin-Tudor Luca7Cristian Mornos8Dragos Cozma9Diana-Aurora Arnăutu10Doctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Internal Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDoctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDoctoral School, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Cardiology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, RomaniaMultidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania<b>Background</b>: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. <b>Methods</b>: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14–22 months), including major adverse cardiac events (MACEs). Kaplan–Meier and Cox regression analyses were performed. <b>Results</b>: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, <i>p</i> = 0.04). Male sex (OR 0.30; 95% CI: 0.14–0.65; <i>p</i> < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45–1.85; <i>p</i> < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, <i>p</i> < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181–0.557; <i>p</i> < 0.0001). <b>Conclusions</b>: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women.https://www.mdpi.com/2227-9059/13/7/1782STEMIleft ventricular remodelingmyocardial worksex differencesglobal work efficiencyechocardiography |
| spellingShingle | Bogdan-Flaviu Buz Sergiu-Florin Arnautu Mirela-Cleopatra Tomescu Minodora Andor Simina Crisan Dan Gaita Cristina Vacarescu Constantin-Tudor Luca Cristian Mornos Dragos Cozma Diana-Aurora Arnăutu Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty Biomedicines STEMI left ventricular remodeling myocardial work sex differences global work efficiency echocardiography |
| title | Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty |
| title_full | Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty |
| title_fullStr | Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty |
| title_full_unstemmed | Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty |
| title_short | Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty |
| title_sort | sex specific patterns and predictors of reverse left ventricular remodeling and outcomes in stemi patients with lvef ≤ 50 after successful primary angioplasty |
| topic | STEMI left ventricular remodeling myocardial work sex differences global work efficiency echocardiography |
| url | https://www.mdpi.com/2227-9059/13/7/1782 |
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