investigate whether the end-systolic wall stress is a predictor of left ventricular remodeling (LVR) in the aftermath of an acute myocardial infarction after successful reperfusion.

LVR is a poor prognosis outcome associated with a greater number of major adverse cardiovascular events. It remains difficult to predict which patients will remodel.

169 STEMI patients were prospectively included in a CMR study. We calculate, among other parameters, end-systolic wall stress (WS) by three-dimensional MRI method with an home-made software. CMR was performed at day 5±2 and repeated at 3 months follow-up. LVR was defined as a LV end-diastolic volume indexed (LVEDVi) >120ml/m² at 3 months.

13 patients presented LVR, including 11 due to anterior MI. LVR patients presented worse initial CMR parameters: WS 25.9±6 vs 16.0±4103N•m-2 (p <0.001), a LVEDVi 117.2±20 vs 84.6±16ml/m² (p<0.001), an infarct size 46.6±20 vs 22.8±15g (p <0.001), a microvascular obstruction size 8.7±1.9 vs 9±3g (p <0.001) and a LV ejection fraction 31.0±8 vs 49.0±9% (p <0.001). The initial global WS emerges as an independent predictor of LVR (OR 1.298 [1.046 to 1.612], p <0.018) as LVEDVi (OR 1.093 [1.013 to 1.180], p <0.022) and the occurrence of heart failure (OR 9.912 [1.094 to 89.842], p <0.041). LVEF as infarct and microvascular obstruction size were not independent predictors. Patients with an initial global WS below 20.88 103 N•m-2 will not develop LVR in 98.5% of cases (sensitivity and specificity of 84.6%).

end-systolic wall stress is an independent predictor of LV remodeling in post-MI. Patients with an initial global WS below 20.88 103N•m-2 presented lower risk for LVR.