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

BackgroundApproximately 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 ResultsIn 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.ConclusionsLVH 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.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.

Importance of elevated heart rate in the very early phase of ST-segment elevation myocardial infarction: Results from the DANAMI-3 trial

“…The CMR protocol and the image analyses have previously been described in detail. 17 Patients without CMR-related exclusion criteria underwent an in-hospital CMR examination during the index admission, following the primary PCI, and a follow-up examination approximately three months later to assess acute and final infarct size, acute and final myocardial salvage index, acute and final LVEF and MVO. Both CMR examinations were performed on a 1.5 T scanner (Siemens, Erlangen, Germany) using a six-channel body array coil.…”

Effects of trimetazidine on ventricular remodeling in coronary artery disease patients with left ventricular hypertrophy: the rationale and design of a randomized controlled trial

“…Left ventricular hypertrophy (LVH), an increase in muscle mass of left ventricle, has been identified as a powerful risk factor for future cardiovascular morbidity and mortality, with the risk of cardiovascular events increasing six-fold to eightfold [3]. In addition, LVH is independently associated with a higher risk of all-cause mortality and a higher incidence of heart failure in CAD patients treated with percutaneous coronary intervention (PCI) [4][5][6]. LVH can develop myocytes death and fibrotic remodeling, and this promotes cardiac dysfunction [7], leading to cardiac hypoxia [8].…”

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“…Emerging evidence has demonstrated that left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular events and increases the risk of acute myocardial infarction (AMI) . LVH is present in approximately one‐third patients with AMI and is causally related to increased morbidity and mortality following AMI . Moreover, experimental studies have shown that animals with LVH have expanded myocardial infarct size and are refractory to cardioprotective treatments due to defective cytoprotective mechanisms following myocardial ischaemia–reperfusion (MI/R) .…”