Prediction of 6 months left ventricular dilatation after myocardial infarction in relation to cardiac morbidity and mortality. Application of a new dilatation model to GISSI-3 data

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Abstract
Aims To predict the long-term left ventricular volume index early after myocardial infarction and to investigate the relationship between long-term left ventricular dilatation risk and clinical outcome. Methods and Results By applying a previously developed dilatation model, we predicted the 6-month left ventricular volume index early after myocardial infarction (median 9 days) in 13679 GISSI-3 patients, to identify patients at high risk of long-term left ventricular dilatation. The left ventricular systolic and diastolic volume indexes at 6 months were predicted with r=0·72 and r=0·68, respectively, in the subgroup of patients in whom a pre-discharge echo was available (n=7842). Patients predicted to be at risk for long-term left ventricular dilatation had an increased risk of mortality (RR 1·87, 95% CI: 1·48 to 2·36) and heart failure at 6 months (RR 2·59, 95% CI:2·04 to 3·28), but no increased risk of reinfarction at 6 months (RR 1·12, 95% CI: 0·87 to 1·45) or of angina pectoris (RR 1·07, 95% CI: 0·95 to 1·20). Conclusion Our prediction of long-term left ventricular dilatation, obtained by applying our new dilatation model in over 13000 GISSI-3 patients, correlated well with mortality and heart failure after myocardial infarction. Therefore, our new dilatation model may contribute to more efficient risk stratification early after myocardial infarction.

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