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

Lars Nepper-Christensen; Jacob Lønborg; Kiril Aleksov Ahtarovski; Dan Eik Høfsten; Kasper Kyhl; Adam Ali Ghotbi; Mikkel Malby Schoos; Christoffer Göransson; Litten Bertelsen; Lars Køber; Steffen Helqvist; Frants Pedersen; Kari Saünamaki; Erik Jørgensen; Henning Kelbæk; Lene Holmvang; Niels Vejlstrup; Thomas Engstrøm

doi:10.1161/JAHA.116.004823

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

Lars Nepper-Christensen^*, Jacob Lønborg, Kiril Aleksov Ahtarovski, Dan Eik Høfsten, Kasper Kyhl, Adam Ali Ghotbi, Mikkel Malby Schoos, Christoffer Göransson, Litten Bertelsen, Lars Køber, Steffen Helqvist, Frants Pedersen, Kari Saünamaki, Erik Jørgensen, Henning Kelbæk, Lene Holmvang, Niels Vejlstrup, Thomas Engstrøm

^*Corresponding author for this work

Department of Clinical Medicine

25 Citations (Scopus)

51 Downloads (Pure)

Abstract

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.

Original language	English
Article number	e004823
Journal	Journal of the American Heart Association
Volume	6
Issue number	1
Number of pages	15
ISSN	2047-9980
DOIs	https://doi.org/10.1161/JAHA.116.004823
Publication status	Published - Jan 2017

Keywords

Cardiac magnetic resonance imaging
Left ventricular hypertrophy
Myocardial infarction
Primary percutaneous coronary intervention
ST-segment elevation myocardial infarction

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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 InterventionFinal published version, 1.08 MBLicence: CC BY-NC-ND

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Nepper-Christensen, L., Lønborg, J., Ahtarovski, K. A., Høfsten, D. E., Kyhl, K., Ghotbi, A. A., Schoos, M. M., Göransson, C., Bertelsen, L., Køber, L., Helqvist, S., Pedersen, F., Saünamaki, K., Jørgensen, E., Kelbæk, H., Holmvang, L., Vejlstrup, N., & Engstrøm, T. (2017). 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. Journal of the American Heart Association, 6(1), Article e004823. https://doi.org/10.1161/JAHA.116.004823

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 et al.
In: Journal of the American Heart Association, Vol. 6, No. 1, e004823, 01.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Nepper-Christensen, L, Lønborg, J, Ahtarovski, KA, Høfsten, DE, Kyhl, K, Ghotbi, AA, Schoos, MM, Göransson, C, Bertelsen, L, Køber, L, Helqvist, S, Pedersen, F, Saünamaki, K, Jørgensen, E, Kelbæk, H, Holmvang, L, Vejlstrup, N & Engstrøm, T 2017, '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', Journal of the American Heart Association, vol. 6, no. 1, e004823. https://doi.org/10.1161/JAHA.116.004823

Nepper-Christensen L, Lønborg J, Ahtarovski KA, Høfsten DE, Kyhl K, Ghotbi AA et al. 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. Journal of the American Heart Association. 2017 Jan;6(1):e004823. doi: 10.1161/JAHA.116.004823

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title = "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",

abstract = "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.",

keywords = "Cardiac magnetic resonance imaging, Left ventricular hypertrophy, Myocardial infarction, Primary percutaneous coronary intervention, ST-segment elevation myocardial infarction",

author = "Lars Nepper-Christensen and Jacob L{\o}nborg and Ahtarovski, {Kiril Aleksov} and H{\o}fsten, {Dan Eik} and Kasper Kyhl and Ghotbi, {Adam Ali} and Schoos, {Mikkel Malby} and Christoffer G{\"o}ransson and Litten Bertelsen and Lars K{\o}ber and Steffen Helqvist and Frants Pedersen and Kari Sa{\"u}namaki and Erik J{\o}rgensen and Henning Kelb{\ae}k and Lene Holmvang and Niels Vejlstrup and Thomas Engstr{\o}m",

year = "2017",

month = jan,

doi = "10.1161/JAHA.116.004823",

language = "English",

volume = "6",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

number = "1",

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TY - JOUR

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

SN - 2047-9980

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 1

M1 - e004823

ER -