Reverse Left Ventricular Remodeling in Patients with Multivessel Myocardial Infarction after Revascularization

The role of factors leading to reverse LV remodeling in patients with multivessel ischemic heart disease after percutaneous coronary intervention (PCI) has not been sufficiently studied. The purpose of this article is to provide a brief and concise review of the current understanding of the pathophysiology, clinical predictors, and studies of LV reverse remodeling after complete and incomplete revascularization in patients with multivessel coronary disease. Materials and methods. A systematic review and meta-analysis was conducted in the search systems: eLIBRARY.RU, PubMed, Medline, ResearchGate, Connected papers and Google Scholar mainly from 2019 to 2024 (85.7 %). Results. The cumulative evidence suggests that key factors that can initiate and maintain remodeling processes include myocardial ischemic injury, chronic inflammation, neurohormonal activation, and oxidative stress. A decrease in all these factors can lead to reverse myocardial remodeling. This is possible with complete revascularization during primary PCI, which leads to improved clinical course and reduced 30-day, 1-year and 3-year mortality rates. A combination of biomarkers from different groups may be suitable for predicting reverse remodeling (brain natriuretic peptide precursor-N-terminal natriuretic hormone propeptide, high-sensitivity troponins, C-reactive protein and creatinine kinase), as well as echocardiographic findings, especially 3D-echocardiographic assessments of ventricular volumes, mass and ejection fraction. Conclusion. Complete revascularization is feasible and has great advantages over revascularization of only one infarct-related coronary artery.