Sebastian J Reinstadler1, Thomas Stiermaier1, Charlotte Eitel1, Georg Fuernau1, Mohammed Saad1, Janine Pöss1, Suzanne de Waha1, Meinhard Mende1, Steffen Desch1, Bernhard Metzler1, Holger Thiele1, Ingo Eitel2. 1. From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical Trial Center Leipzig, University of Leipzig, Germany (M.M.); and Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Germany (S.d.W., S.D., H.T.). 2. From the University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (S.J.R., T.S., C.E., G.F., M.S., J.P., S.d.W., S.D., I.E.); University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria (S.J.R., B.M.); Clinical Trial Center Leipzig, University of Leipzig, Germany (M.M.); and Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Germany (S.d.W., S.D., H.T.). ingoeitel@gmx.de.
Abstract
BACKGROUND:Atrial fibrillation (AF) is frequently observed in patients with ST-segment-elevation myocardial infarction and associated with worse clinical outcome. However, the mechanisms for this increased risk are not fully understood. The purpose of this study was to investigate the relationship of the presence of AF to cardiac magnetic resonance (CMR) derived myocardial salvage and damage as well as clinical outcomes. METHODS AND RESULTS: This multicenter CMR study enrolled 786 patients with ST-segment-elevation myocardial infarction. CMR parameters (infarct size, myocardial salvage index, microvascular obstruction, and myocardial function) were assessed 3 (interquartile range [IQR], 2-4) days post-ST-segment-elevation myocardial infarction and compared between patients with or without AF during hospitalization. Major adverse cardiac events were assessed as a composite of all-cause death, reinfarction, and new congestive heart failure at 12 months. AF was documented in 48 (6.1%) patients. There was no significant difference in infarct size (18 [IQR, 9-29]% versus 17 [IQR, 9-25]% of left ventricular mass; P=0.340), myocardial salvage index (51 [IQR, 34-69] versus 51 [IQR, 33-69]; P=0.830), or microvascular obstruction (0.6 [IQR, 0-2.0]% versus 0.0 [IQR, 0-1.8]% of left ventricular mass; P=0.340) between groups. Patients with AF had significantly lower left ventricular (47 [IQR, 34-54]% versus 51 [IQR, 44-58]%; P=0.003) and left atrial (42 [IQR, 17-57]% versus 53 [IQR, 45-59]%; P<0.001) ejection fraction. AF was associated with major adverse cardiac events, even when adjusting for clinical risk factors (odds ratio, 2.48 [95% confidence interval, 1.22-5.03]; P=0.0120) or CMR prognosis markers (odds ratio, 3.77 [95% confidence interval, 1.83-7.79]; P=0.001). CONCLUSIONS: This CMR study found no major differences in myocardial salvage, infarct size, or microvascular damage in patients with ST-segment-elevation myocardial infarction or without AF. AF was, however, associated with cardiac dysfunction and independently related to major adverse cardiac events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.
RCT Entities:
BACKGROUND:Atrial fibrillation (AF) is frequently observed in patients with ST-segment-elevation myocardial infarction and associated with worse clinical outcome. However, the mechanisms for this increased risk are not fully understood. The purpose of this study was to investigate the relationship of the presence of AF to cardiac magnetic resonance (CMR) derived myocardial salvage and damage as well as clinical outcomes. METHODS AND RESULTS: This multicenter CMR study enrolled 786 patients with ST-segment-elevation myocardial infarction. CMR parameters (infarct size, myocardial salvage index, microvascular obstruction, and myocardial function) were assessed 3 (interquartile range [IQR], 2-4) days post-ST-segment-elevation myocardial infarction and compared between patients with or without AF during hospitalization. Major adverse cardiac events were assessed as a composite of all-cause death, reinfarction, and new congestive heart failure at 12 months. AF was documented in 48 (6.1%) patients. There was no significant difference in infarct size (18 [IQR, 9-29]% versus 17 [IQR, 9-25]% of left ventricular mass; P=0.340), myocardial salvage index (51 [IQR, 34-69] versus 51 [IQR, 33-69]; P=0.830), or microvascular obstruction (0.6 [IQR, 0-2.0]% versus 0.0 [IQR, 0-1.8]% of left ventricular mass; P=0.340) between groups. Patients with AF had significantly lower left ventricular (47 [IQR, 34-54]% versus 51 [IQR, 44-58]%; P=0.003) and left atrial (42 [IQR, 17-57]% versus 53 [IQR, 45-59]%; P<0.001) ejection fraction. AF was associated with major adverse cardiac events, even when adjusting for clinical risk factors (odds ratio, 2.48 [95% confidence interval, 1.22-5.03]; P=0.0120) or CMR prognosis markers (odds ratio, 3.77 [95% confidence interval, 1.83-7.79]; P=0.001). CONCLUSIONS: This CMR study found no major differences in myocardial salvage, infarct size, or microvascular damage in patients with ST-segment-elevation myocardial infarction or without AF. AF was, however, associated with cardiac dysfunction and independently related to major adverse cardiac events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.
Authors: Karl J Weiss; Sarah B Nasser; Tamar Bigvava; Adelina Doltra; Bernhard Schnackenburg; Alexander Berger; Markus S Anker; Christian Stehning; Patrick Doeblin; Mohamed Abdelmeguid; Mohamed Talat; Rolf Gebker; Wael E-Naggar; Burkert Pieske; Sebastian Kelle Journal: ESC Heart Fail Date: 2021-12-06
Authors: Magdalena Holzknecht; Christina Tiller; Martin Reindl; Ivan Lechner; Priscilla Fink; Patrick Lunger; Agnes Mayr; Benjamin Henninger; Christoph Brenner; Gert Klug; Axel Bauer; Bernhard Metzler; Sebastian Johannes Reinstadler Journal: J Clin Med Date: 2021-11-24 Impact factor: 4.241
Authors: Martin Reindl; Thomas Stiermaier; Ivan Lechner; Christina Tiller; Magdalena Holzknecht; Agnes Mayr; Johannes P Schwaiger; Christoph Brenner; Gert Klug; Axel Bauer; Holger Thiele; Hans-Josef Feistritzer; Bernhard Metzler; Ingo Eitel; Sebastian J Reinstadler Journal: Eur Heart J Open Date: 2021-11-09