Sören J Backhaus1,2, Johannes T Kowallick2,3, Thomas Stiermaier4,5, Torben Lange1,2, Alexander Koschalka1,2, Jenny-Lou Navarra1,2, Joachim Lotz2,3, Shelby Kutty6, Boris Bigalke7, Matthias Gutberlet8, Hans-Josef Feistritzer9, Gerd Hasenfuß1,2, Holger Thiele9, Andreas Schuster10,11,12, Ingo Eitel4,5. 1. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. 2. German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. 3. Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. 4. Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany. 5. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. 6. Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, NE, 68114, USA. 7. Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany. 8. Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 9. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 10. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. andreas_schuster@gmx.net. 11. German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. andreas_schuster@gmx.net. 12. Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, 5th Floor, Acute Services Building, Reserve Road, St Leonard's, Sydney, NSW, 2065, Australia. andreas_schuster@gmx.net.
Abstract
BACKGROUND: Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct-related artery (IRA)-subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA-associated pathophysiological consequences using cardiac magnetic resonance (CMR). METHODS:1235 AMI patients (n = 795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction. RESULTS: LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular [LV ejection fraction (EF) 47.4%, GLS - 13.2%, GCS - 20.8%] and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS - 17.4%, GCS - 25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS - 19.1%, GCS - 26.6%, εs 21.7%). In AUC analyses, εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC > 0.69). Multivariate analyses identified εs (p = 0.017) in LAD and GLS (p = 0.034) in LCx infarcts as independent predictors of MACE. CONCLUSIONS: CMR allows IRA-specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct-specific prognostic implications, and may represent novel diagnostic and therapeutic targets following AMI. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00712101 and NCT01612312.
RCT Entities:
BACKGROUND: Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct-related artery (IRA)-subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA-associated pathophysiological consequences using cardiac magnetic resonance (CMR). METHODS: 1235 AMI patients (n = 795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction. RESULTS:LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular [LV ejection fraction (EF) 47.4%, GLS - 13.2%, GCS - 20.8%] and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS - 17.4%, GCS - 25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS - 19.1%, GCS - 26.6%, εs 21.7%). In AUC analyses, εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC > 0.69). Multivariate analyses identified εs (p = 0.017) in LAD and GLS (p = 0.034) in LCx infarcts as independent predictors of MACE. CONCLUSIONS: CMR allows IRA-specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct-specific prognostic implications, and may represent novel diagnostic and therapeutic targets following AMI. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00712101 and NCT01612312.
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