Cardiometabolic index as a predictor of left ventricular remodeling post myocardial infarction
DOI:
https://doi.org/10.18203/2349-3933.ijam20261887Keywords:
Cardiometabolic index, Insulin resistance, Left ventricular remodeling, Myocardial infarction, Post-infarction outcomesAbstract
Myocardial Infarction has left an imprint on the heart in the form of left ventricular remodeling, which is the most important factor in the progression of heart failure and the gaining or losing of long-term cardiovascular prognosis. Traditional risk assessment has a narrow vision on metabolic factors which are most influential in the process of cardiac repair after the event. The cardiometabolic index, a composite of central adiposity along with dyslipidemia, is being recognized as a very easy and simple to use marker that reflects the metabolic stress situation. Observational studies have reported that increased cardiometabolic index is associated with unfavorable left ventricular structural changes such as concentric remodeling and hypertrophy along with decreased diastolic function indicating its use in predicting post-myocardial infarction outcomes. However, the majority of the data available so far come from studies of the general population rather than myocardial infarction-specific groups; yet the reasoning behind the mechanistic pathway is strong enough to support its presence in the post-infarction context where it provides a biologically plausible link between metabolic dysregulation and unfavorable changes in ventricle remodeling. This review presents the current evidence regarding cardiometabolic index and left ventricular remodeling, discusses its role in risk stratification and recognizes the lack of research in this regard. In order to prove cardiometabolic index as a predictor to assess its application in directing personalized interventions aimed at enhancing myocardial recovery, and to increase the associated life span of patients with heart problems, future clinical trials focusing on post-myocardial infarction patients are absolutely necessary.
Metrics
References
Liu C, Jin Q, Han C, Jiao M. Global, regional, and national burden of ischaemic heart disease from 1990 to 2021: a comprehensive analysis based on the Global Burden of Disease study 2021. J Glob Health. 2025;15:04291. DOI: https://doi.org/10.7189/jogh.15.04291
Marcos-Garcés V, Bertolín-Boronat C, Merenciano-González H, Martínez Mas ML, Climent Alberola JI, López-Bueno L, et al. Left ventricular remodeling after myocardial infarction-pathophysiology, diagnostic approach and management during cardiac rehabilitation. Int J Mol Sci. 2025;26:10964. DOI: https://doi.org/10.3390/ijms262210964
Chimed S, Van der Bijl P, Lustosa R, Fortuni F, Montero-Cabezas JM, Ajmone Marsan N, et al. Functional classification of left ventricular remodelling: prognostic relevance in myocardial infarction. ESC Heart Fail. 2022;9:912-24. DOI: https://doi.org/10.1002/ehf2.13802
Frantz S, Hundertmark MJ, Schulz-Menger J, Bengel FM, Bauersachs J. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. Eur Heart J. 2022;43:2549-61.
Berezin AE, Berezin AA. Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers. Dis Markers. 2020;2020:1215802. DOI: https://doi.org/10.1155/2020/1215802
Ashfield S, Ojha U. Cardiometabolic dysregulation and heart failure. Rev Cardiovasc Med. 2025;26:38504. DOI: https://doi.org/10.31083/RCM38504
Tune JD, Goodwill AG, Sassoon DJ, Mather KJ. Cardiovascular consequences of metabolic syndrome. Transl Res. 2017;183:57-70. DOI: https://doi.org/10.1016/j.trsl.2017.01.001
Mouton AJ, Flynn ER, Moak SP, Li X, Da Silva AA, Wang Z, et al. Interaction of obesity and hypertension on cardiac metabolic remodeling and survival following myocardial infarction. J Am Heart Assoc. 2021;10:e018212. DOI: https://doi.org/10.1161/JAHA.120.018212
Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K. Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLoS One. 2017;12:e0177175. DOI: https://doi.org/10.1371/journal.pone.0177175
Kim J, Kang S, Kang H. normal-weight obesity and metabolic syndrome in korean adults: a population-based cross-sectional study. Healthcare. 2023;11:2303. DOI: https://doi.org/10.3390/healthcare11162303
Wang Y, Wang H, Liu X, Zhang J. Improving cardiometabolic multimorbidity prediction with a composite obesity-TyG index: a study of middle-aged and older adults in CHARLS. Arch Public Health. 2025;83:271. DOI: https://doi.org/10.1186/s13690-025-01762-6
Duan S, Yang D, Xia H, Ren Z, Chen J, Yao S. Cardiometabolic index: A new predictor for metabolic associated fatty liver disease in Chinese adults. Front Endocrinol. 2022;13:1004855. DOI: https://doi.org/10.3389/fendo.2022.1004855
Luo Y, Yin Z, Li X, Sheng C, Zhang P, Wang D, et al. Cardiometabolic index predicts cardiovascular events in aging population: a machine learning-based risk prediction framework from a large-scale longitudinal study. Front Endocrinol. 2025;16:1551779. DOI: https://doi.org/10.3389/fendo.2025.1551779
Zhu XM, Xu Y, Zhang J. Cardiometabolic Index is associated with heart failure: a cross-sectional study based on NHANES. Front Med. 2024;11:1507100. DOI: https://doi.org/10.3389/fmed.2024.1507100
Wang H, Sun Y, Li Z, Guo X, Chen S, Ye N, et al. Gender-specific contribution of cardiometabolic index and lipid accumulation product to left ventricular geometry change in general population of rural China. BMC Cardiovasc Disord. 2018;18:62.
Chen F, Niu Y, Wu R, Jiang H, Zhu J, Wang C, et al. Association between cardiometabolic index and cardiovascular disease: evidence From the NHANES 2007-2018. Front Cardiovasc Med. 2025;12:1516591.
Chung E, Zhang D, Gonzalez Porras M, Hsu CG. TREM2 as a regulator of obesity-induced cardiac remodeling: mechanisms and therapeutic insights. Am J Physiol Heart Circ Physiol. 2025;328:H1073-82. DOI: https://doi.org/10.1152/ajpheart.00075.2025
Nguyen NT, Nguyen TN, Nguyen KM, Tran HPN, Huynh KLA, Hoang SV. Prevalence and impact of metabolic syndrome on in-hospital outcomes in patients with acute myocardial infarction: A perspective from a developing country. Medicine. 2023;102:e35924. DOI: https://doi.org/10.1097/MD.0000000000035924
Gerber Y, Weston SA, Enriquez-Sarano M, Jaffe AS, Manemann SM, Jiang R, et al. Contemporary risk stratification after myocardial infarction in the community: performance of scores and incremental value of soluble suppression of tumorigenicity-2. J Am Heart Assoc. 2017;6:e005958. DOI: https://doi.org/10.1161/JAHA.117.005958
Heerkens L, Van Kleef LA, De Knegt RJ, Voortman T, Geleijnse JM. Fatty liver index and mortality after myocardial infarction: A prospective analysis in the alpha omega cohort. PLoS One. 2023;18:e0287467. DOI: https://doi.org/10.1371/journal.pone.0287467
Sha X, Wang W, Wang J, Wang R. Relationship Between Cardiometabolic Index and Post-PCI Coronary Microvascular Dysfunction in Acute STEMI Patients. J Multidiscip Healthc. 2025;18:5591-602.
Jiang L, Li Y, Li XM, Shi K, Fang H, Yan WF, et al. The adverse effects of metabolic disorder on left ventricular myocardial mechano-energetic efficiency and dysfunction in ischemic cardiomyopathy: insight from a cardiac MRI study. Cardiovasc Diabetol. 2025;24:261. DOI: https://doi.org/10.1186/s12933-025-02817-2
Xu B, Li W, You Z, Yang N, Lin L, Li Y. Risk factors for left ventricular remodeling after myocardial infarction: A meta-analysis. Medicine. 2024;103:e40496. DOI: https://doi.org/10.1097/MD.0000000000040496
Wang H, Sun Y, Li Z, Guo X, Chen S, Ye N, et al. Gender-specific contribution of cardiometabolic index and lipid accumulation product to left ventricular geometry change in general population of rural China. BMC Cardiovasc Disord. 2018;18:62. DOI: https://doi.org/10.1186/s12872-018-0798-0
Gruzdeva O, Uchasova E, Dyleva Y, Akbasheva O, Matveeva V, Karetnikova V, et al. Relationship key factor of inflammation and the development of complications in the late period of myocardial infarction in patients with visceral obesity. BMC Cardiovasc Disord. 2017;17:36. DOI: https://doi.org/10.1186/s12872-017-0473-x
Fonseca FA, Izar MC. Role of Inflammation in cardiac remodeling after acute myocardial infarction. Front Physiol. 2022;13:927163. DOI: https://doi.org/10.3389/fphys.2022.927163
Sha X, Wang W, Wang J, Wang R. Relationship between cardiometabolic index and post-pci coronary microvascular dysfunction in acute stemi patients. J Multidiscip Healthc. 2025;18:5591-602. DOI: https://doi.org/10.2147/JMDH.S549547
Ramirez AY, Doman ER, Sanchez K, Chilton RJ. Impact of insulin resistance and microvascular ischemia on myocardial energy metabolism and cardiovascular function: pathophysiology and therapeutic approaches. Cardiovasc Endocrinol Metab. 2025;14:e00332. DOI: https://doi.org/10.1097/XCE.0000000000000332
Abel ED, O'Shea KM, Ramasamy R. Insulin resistance: metabolic mechanisms and consequences in the heart. Arterioscler Thromb Vasc Biol. 2012;32:2068-76. DOI: https://doi.org/10.1161/ATVBAHA.111.241984
Chen L, Chen M, Yang X, Hu Y, Qiu C, Fu Y, et al. Energy metabolism in cardiovascular diseases: unlocking the hidden powerhouse of cardiac pathophysiology. Front Endocrinol. 2025;16:1617305. DOI: https://doi.org/10.3389/fendo.2025.1617305
Puchałowicz K, Kłoda K, Dziedziejko V, Rać M, Wojtarowicz A, Chlubek D, et al. Association of adiponectin, leptin and resistin plasma concentrations with echocardiographic parameters in patients with coronary artery disease. Diagnostics. 2021;11:1774. DOI: https://doi.org/10.3390/diagnostics11101774
Shah RV, Abbasi SA, Heydari B, Rickers C, Jacobs DR, Wang L, et al. Insulin resistance, subclinical left ventricular remodeling, and the obesity paradox: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;61:1698-706.
Peng X, Du J, Wang Y. Metabolic signatures in post-myocardial infarction heart failure, including insights into prediction, intervention, and prognosis. Biomed Pharmacother. 2024;170:116079. DOI: https://doi.org/10.1016/j.biopha.2023.116079
Garza MA, Wason EA, Zhang JQ. Cardiac remodeling and physical training post myocardial infarction. World J Cardiol. 2015;7:52-64. DOI: https://doi.org/10.4330/wjc.v7.i2.52
Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2017;14:30-8. DOI: https://doi.org/10.1038/nrcardio.2016.163
Bostan MM, Stătescu C, Anghel L, Șerban IL, Cojocaru E, Sascău R. Post-myocardial infarction ventricular remodeling biomarkers-the key link between pathophysiology and clinic. Biomolecules. 2020;10:1587. DOI: https://doi.org/10.3390/biom10111587
Parisi V, Cabaro S, D'Esposito V, Petraglia L, Conte M, Campana P, et al. Epicardial adipose tissue and il-13 response to myocardial injury drives left ventricular remodeling after st elevation myocardial infarction. Front Physiol. 2022;11:575181. DOI: https://doi.org/10.3389/fphys.2020.575181
Gavara J, Merenciano-Gonzalez H, Llopis-Lorente J, Molina-Garcia T, Perez-Solé N, De Dios E, et al. Impact of epicardial adipose tissue on infarct size and left ventricular systolic function in patients with anterior st-segment elevation myocardial infarction. Diagnostics. 2024;14:368. DOI: https://doi.org/10.3390/diagnostics14040368
Bond RM, Ivy K, Crumbs T, Purewal V, Obang S, Sraow DIS. Coronary microvascular dysfunction and its role in heart failure with preserved ejection fraction for future prevention and treatment. Am J Prev Cardiol. 2025;22:100983. DOI: https://doi.org/10.1016/j.ajpc.2025.100983
Cai X, Hu J, Wen W, Wang J, Wang M, Liu S, et al. associations of the cardiometabolic index with the risk of cardiovascular disease in patients with hypertension and obstructive sleep apnea: results of a longitudinal cohort study. Oxid Med Cell Longev. 2022;2022:4914791. DOI: https://doi.org/10.1155/2022/4914791
Szczepańska E, Słoma-Krześlak M, Białek-Dratwa A, Dudzik I, Kowalski O. Adipose dysfunction indices as a key to cardiometabolic risk assessment-a population-based study of post-myocardial infarction patients. Metabolites. 2024;14:299. DOI: https://doi.org/10.3390/metabo14060299
Colivicchi F, Di Fusco SA, Gulizia MM, De Luca L, Geraci G, Nardi F, et al. Risk stratification and secondary prevention post-myocardial infarction: insights from the EYESHOT Post-MI study. J Cardiovasc Med. 2021;22:478-85. DOI: https://doi.org/10.2459/JCM.0000000000001132
Tanasescu MD, Rosu AM, Minca A, Rosu AL, Grigorie MM, Timofte D, et al. beyond bmi: rethinking obesity metrics and cardiovascular risk in the era of precision medicine. Diagnostics. 2025;15:3025. DOI: https://doi.org/10.3390/diagnostics15233025
Frantz S, Hundertmark MJ, Schulz-Menger J, Bengel FM, Bauersachs J. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. Eur Heart J. 2022;43:2549-61. DOI: https://doi.org/10.1093/eurheartj/ehac223
Zhuo L, Lai M, Wan L, Zhang X, Chen R. Cardiometabolic index and the risk of new-onset chronic diseases: results of a national prospective longitudinal study. Front Endocrinol. 2024;15:1446276. DOI: https://doi.org/10.3389/fendo.2024.1446276
Jin JL, Cao YX, Wu LG, You XD, Guo YL, Wu NQ, et al. Triglyceride glucose index for predicting cardiovascular outcomes in patients with coronary artery disease. J Thorac Dis. 2018;10:6137-46. DOI: https://doi.org/10.21037/jtd.2018.10.79
Wang R, Liu J, Fang G, Shi J, Zhang C, Huang Y. Association between visceral adiposity index and cardiovascular disease: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis. 2025;35:104216. DOI: https://doi.org/10.1016/j.numecd.2025.104216
Khanmohammadi S, Tavolinejad H, Aminorroaya A, Rezaie Y, Ashraf H, Vasheghani-Farahani A. Association of lipid accumulation product with type 2 diabetes mellitus, hypertension, and mortality: a systematic review and meta-analysis. J Diabetes Metab Disord. 2022;21:1943-73. DOI: https://doi.org/10.1007/s40200-022-01114-z
Torres-Orozco AK, De León LG, Ortiz-Rodríguez B, Candia-Luján R. Wakabayashi and Daimon cardiometabolic index as an indicator to assess risk in adults. A systematic review. Aten Primaria. 2024;56:102846. DOI: https://doi.org/10.1016/j.aprim.2023.102846
Bodenstab ML, Varghese RT, Iacobellis G. Cardio-lipotoxicity of epicardial adipose tissue. Biomolecules. 2024;14:1465. DOI: https://doi.org/10.3390/biom14111465
Sha J, Cheng J, Qiu X, Pan M, Liu C, Shen L, et al. Cardiometabolic index as a predictor of major adverse cardiovascular events in atrial fibrillation: insights from a community-based cohort. Front Endocrinol. 2025;16:1682622. DOI: https://doi.org/10.3389/fendo.2025.1682622
D'Amario D, Laborante R, Bianchini E, Ciliberti G, Paglianiti DA, Galli M, et al. Impact of coronary microvascular dysfunction in heart failure with preserved ejection fraction: a meta-analysis. ESC Heart Fail. 2024;11:2063-75. DOI: https://doi.org/10.1002/ehf2.14626
Tsai KZ, Liu PY, Huang WC, Lima JAC, Lavie CJ, Lin GM. Sex-specific cardiometabolic risk markers of left ventricular mass in physically active young adults: the CHIEF heart study. Sci Rep. 2022;12:11536. DOI: https://doi.org/10.1038/s41598-022-15818-y
Shah RV, Abbasi SA, Heydari B, Rickers C, Jacobs DR, Wang L, et al. Insulin resistance, subclinical left ventricular remodeling, and the obesity paradox: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2013;61:1698-706. DOI: https://doi.org/10.1016/j.jacc.2013.01.053
Chen F, Niu Y, Wu R, Jiang H, Zhu J, Wang C, et al. Association between cardiometabolic index and cardiovascular disease: evidence From the NHANES 2007-2018. Front Cardiovasc Med. 2025;12:1516591. DOI: https://doi.org/10.3389/fcvm.2025.1516591
Luo X, Cai B. Association between cardiometabolic index and congestive heart failure among US adults: a cross-sectional study. Front Cardiovasc Med. 2024;11:1433950. DOI: https://doi.org/10.3389/fcvm.2024.1433950
Ye R, Zhang X, Zhang Z, Wang S, Liu L, Jia S, et al. Association of cardiometabolic and triglyceride-glucose index with left ventricular diastolic function in asymptomatic individuals. Nutr Metab Cardiovasc Dis. 2024;34:1590-600. DOI: https://doi.org/10.1016/j.numecd.2024.02.008
Yang D, Li W, Luo W, Yang Y, Yi J, Li C, et al. Association between cardiometabolic index and mortality among patients with atherosclerotic cardiovascular disease: evidence from NHANES 1999-2018. Medicina. 2025;61:1064. DOI: https://doi.org/10.3390/medicina61061064
Yehong L, Yan L, Ke C, Longqun L, Wu G, Gangjun Z. Cardiometabolic index as a novel prognostic biomarker for cardiovascular events in post-percutaneous coronary intervention patients with st-segment elevation myocardial infarction: two-center retrospective study. Curr Med Res Opin. 2025;1-13. DOI: https://doi.org/10.1080/03007995.2025.2605695
Zhu M, Jin H, Yin Y, Xu Y, Zhu Y. Association of cardiometabolic index with all-cause and cardiovascular mortality among middle-aged and elderly populations. Sci Rep. 2025;15:681.
Ramos-Regalado L, Alcover S, Badimon L, Vilahur G. The influence of metabolic risk factors on the inflammatory response triggered by myocardial infarction: bridging pathophysiology to treatment. Cells. 2024;13:1125. DOI: https://doi.org/10.3390/cells13131125
Li J, Wei X. Baseline and changes in cardiometabolic index and incident cardiovascular disease in two prospective cohorts. Am J Prev Cardiol. 2025;23:101046. DOI: https://doi.org/10.1016/j.ajpc.2025.101046
Zhu M, Jin H, Yin Y, Xu Y, Zhu Y. Association of cardiometabolic index with all-cause and cardiovascular mortality among middle-aged and elderly populations. Sci Rep. 2025;15:681. DOI: https://doi.org/10.1038/s41598-024-83914-2
Zhang J, Jiang J, Zhao J, Chen K, Yuan P, Wang Y, et al. Association between cardiometabolic index and myocardial Infarction: based on NHANES database. Acta Cardiol. 2025;80:163-72. DOI: https://doi.org/10.1080/00015385.2025.2460404
Downloads
Published
How to Cite
Issue
Section
