Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
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Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Nepper-Christensen, Lars; Lønborg, Jacob; Ahtarovski, Kiril Aleksov; Høfsten, Dan Eik; Kyhl, Kasper; Ghotbi, Adam Ali; Schoos, Mikkel Malby; Göransson, Christoffer; Bertelsen, Litten; Køber, Lars; Helqvist, Steffen; Pedersen, Frants; Saünamaki, Kari; Jørgensen, Erik; Kelbæk, Henning; Holmvang, Lene; Vejlstrup, Niels; Engstrøm, Thomas.
I: Journal of the American Heart Association, Bind 6, Nr. 1, e004823, 01.2017.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
AU - Nepper-Christensen, Lars
AU - Lønborg, Jacob
AU - Ahtarovski, Kiril Aleksov
AU - Høfsten, Dan Eik
AU - Kyhl, Kasper
AU - Ghotbi, Adam Ali
AU - Schoos, Mikkel Malby
AU - Göransson, Christoffer
AU - Bertelsen, Litten
AU - Køber, Lars
AU - Helqvist, Steffen
AU - Pedersen, Frants
AU - Saünamaki, Kari
AU - Jørgensen, Erik
AU - Kelbæk, Henning
AU - Holmvang, Lene
AU - Vejlstrup, Niels
AU - Engstrøm, Thomas
PY - 2017/1
Y1 - 2017/1
N2 - Background--Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention. Methods and Results--In this substudy of the DANAMI-3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy-eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range (IQR), 10-21] vs 9% [IQR, 3-17]; P < 0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5-0.7] vs 0.7 [IQR, 0.5-0.9]; P < 0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P < 0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47-60] vs 61% [IQR, 55-65]; P < 0.001). In a Cox regression analysis, LVH was associated with a higher risk of all-cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38-4.90], P=0.003). The results remained statistically significant in multivariable models. Conclusions--LVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all-cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.
AB - Background--Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention. Methods and Results--In this substudy of the DANAMI-3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy-eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range (IQR), 10-21] vs 9% [IQR, 3-17]; P < 0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5-0.7] vs 0.7 [IQR, 0.5-0.9]; P < 0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P < 0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47-60] vs 61% [IQR, 55-65]; P < 0.001). In a Cox regression analysis, LVH was associated with a higher risk of all-cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38-4.90], P=0.003). The results remained statistically significant in multivariable models. Conclusions--LVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all-cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.
KW - Cardiac magnetic resonance imaging
KW - Left ventricular hypertrophy
KW - Myocardial infarction
KW - Primary percutaneous coronary intervention
KW - ST-segment elevation myocardial infarction
U2 - 10.1161/JAHA.116.004823
DO - 10.1161/JAHA.116.004823
M3 - Journal article
C2 - 28069574
AN - SCOPUS:85009951602
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 1
M1 - e004823
ER -
ID: 188394315