Sex-related determinants and outcomes of reverse left ventricular remodeling in STEMI patients with reduced LVEF after primary PCI
D A Arnautu, F B Buz, M Andor, D C Jianu, S F ArnautuAbstract
Background
Sex-related differences in left ventricular (LV) reverse remodeling after ST-segment elevation myocardial infarction (STEMI) remain insufficiently characterized. Reverse remodeling, reflecting recovery of LV structure and function after ischemic injury, is an important determinant of prognosis. Understanding its predictors and sex-specific variations may provide insights for personalized post-infarction management. This study aimed to identify independent predictors of LV reverse remodeling and to evaluate its impact on outcomes, with a specific focus on sex-related patterns.
Methods
A total of 253 consecutive STEMI patients (91 women, 28%) with left ventricular ejection fraction (LVEF) ≤50% after successful primary percutaneous coronary intervention (PCI) were prospectively evaluated. Comprehensive echocardiography was performed at baseline and after six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Myocardial work indices, including global work index (GWI), global constructive work (GCW), and global work efficiency (GWE), were calculated from LV pressure–strain loops. Multivariate logistic regression was used to identify independent predictors of remodeling. Major adverse cardiac events (MACEs)—a composite of cardiovascular death, hospitalization for heart failure, or recurrent infarction—were recorded over a median 17-month follow-up (IQR 14–22). Kaplan–Meier survival curves and Cox proportional hazards regression were applied for outcome analysis.
Results
LV reverse remodeling occurred in 43% of the population and was significantly more frequent in men than in women (47% vs. 37%, p=0.04). Male sex (OR 0.30, 95% CI 0.14–0.65, p<0.0001) and baseline GWE (OR 1.64, 95% CI 1.45–1.85, p<0.0001) independently predicted reverse remodeling. Men demonstrated a greater reduction in LVEDV, more pronounced LVEF improvement, and better recovery of myocardial work parameters compared with women. Over follow-up, patients with reverse remodeling experienced fewer MACEs than those without (10% vs. 24%, p<0.01). In Cox regression, reverse remodeling remained independently protective against adverse outcomes (HR 0.32, 95% CI 0.18–0.56, p<0.0001).
Conclusions
LV reverse remodeling following STEMI is associated with significant improvement in clinical outcomes and demonstrates clear sex-specific differences. Baseline myocardial work parameters, particularly global work efficiency, serve as strong predictors of subsequent LV recovery. Men show greater LV volume reduction, more substantial improvement in systolic function, and superior myocardial work restoration compared with women. These findings underscore the importance of incorporating myocardial work assessment and sex-specific evaluation into post-STEMI risk stratification and follow-up strategies.Sex differences in cardiac remodelingFor image description, please refer to the figure legend and surrounding text.Kaplan–Meier curves free from MACEsFor image description, please refer to the figure legend and surrounding text.