Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction

Bobak Heydari, Shuaib Abdullah, James V. Pottala, Ravi Shah, Siddique Abbasi, Damien Mandry, Sanjeev A. Francis, Heidi Lumish, Brian B. Ghoshhajra, Udo Hoffmann, Evan Appelbaum, Jiazhuo H. Feng, Ron Blankstein, Michael Steigner, Joseph P. McConnell, William Harris, Elliott M. Antman, Michael Jerosch-Herold, Raymond Y. Kwong

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown. Methods: In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size. Results: By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8%, P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13% reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. Conclusions: Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care.

Original languageEnglish (US)
Pages (from-to)378-391
Number of pages14
JournalCirculation
Volume134
Issue number5
DOIs
StatePublished - Aug 2 2016

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Ventricular Remodeling
Omega-3 Fatty Acids
Esters
Myocardial Infarction
Acids
Fibrosis
Placebos
Biomarkers
Guidelines
Inflammation
Intention to Treat Analysis
Fish Oils
Therapeutics
Standard of Care
Serum
Stroke Volume
Blood Vessels
Erythrocytes
Magnetic Resonance Imaging

Keywords

  • endomyocardial fibrosis
  • fatty acids, omega-3
  • infarction
  • magnetic resonance imaging
  • ventricular remodeling

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction. / Heydari, Bobak; Abdullah, Shuaib; Pottala, James V.; Shah, Ravi; Abbasi, Siddique; Mandry, Damien; Francis, Sanjeev A.; Lumish, Heidi; Ghoshhajra, Brian B.; Hoffmann, Udo; Appelbaum, Evan; Feng, Jiazhuo H.; Blankstein, Ron; Steigner, Michael; McConnell, Joseph P.; Harris, William; Antman, Elliott M.; Jerosch-Herold, Michael; Kwong, Raymond Y.

In: Circulation, Vol. 134, No. 5, 02.08.2016, p. 378-391.

Research output: Contribution to journalArticle

Heydari, B, Abdullah, S, Pottala, JV, Shah, R, Abbasi, S, Mandry, D, Francis, SA, Lumish, H, Ghoshhajra, BB, Hoffmann, U, Appelbaum, E, Feng, JH, Blankstein, R, Steigner, M, McConnell, JP, Harris, W, Antman, EM, Jerosch-Herold, M & Kwong, RY 2016, 'Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction', Circulation, vol. 134, no. 5, pp. 378-391. https://doi.org/10.1161/CIRCULATIONAHA.115.019949
Heydari, Bobak ; Abdullah, Shuaib ; Pottala, James V. ; Shah, Ravi ; Abbasi, Siddique ; Mandry, Damien ; Francis, Sanjeev A. ; Lumish, Heidi ; Ghoshhajra, Brian B. ; Hoffmann, Udo ; Appelbaum, Evan ; Feng, Jiazhuo H. ; Blankstein, Ron ; Steigner, Michael ; McConnell, Joseph P. ; Harris, William ; Antman, Elliott M. ; Jerosch-Herold, Michael ; Kwong, Raymond Y. / Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction. In: Circulation. 2016 ; Vol. 134, No. 5. pp. 378-391.
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abstract = "Background: Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown. Methods: In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size. Results: By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8{\%}, P=0.017), and noninfarct myocardial fibrosis (-5.6{\%}, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13{\%} reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. Conclusions: Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care.",
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T1 - Effect of omega-3 acid ethyl esters on left ventricular remodeling after acute myocardial infarction

AU - Heydari, Bobak

AU - Abdullah, Shuaib

AU - Pottala, James V.

AU - Shah, Ravi

AU - Abbasi, Siddique

AU - Mandry, Damien

AU - Francis, Sanjeev A.

AU - Lumish, Heidi

AU - Ghoshhajra, Brian B.

AU - Hoffmann, Udo

AU - Appelbaum, Evan

AU - Feng, Jiazhuo H.

AU - Blankstein, Ron

AU - Steigner, Michael

AU - McConnell, Joseph P.

AU - Harris, William

AU - Antman, Elliott M.

AU - Jerosch-Herold, Michael

AU - Kwong, Raymond Y.

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Y1 - 2016/8/2

N2 - Background: Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown. Methods: In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size. Results: By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8%, P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13% reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. Conclusions: Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care.

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KW - endomyocardial fibrosis

KW - fatty acids, omega-3

KW - infarction

KW - magnetic resonance imaging

KW - ventricular remodeling

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