Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

Abstract

BackgroundHigh aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far.Methods and ResultsThis prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001).ConclusionsIncreased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification.

The role of ventricular–arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association

“…Additionally, an increase of the arterial load due to increased aortic stiffness may also affect LV performance . Increased PWV was related with reduced coronary flow reserve in CAD patients even after successful revascularization and with elevated N‐terminal pro BNP (NT‐proBNP) post‐myocardial infarction ( Table ) . Myocardial strain imaging (LV GLS < 20%) has shown to detect subclinical dysfunction in CAD patients and represents a more sensitive method of identifying LV performance .…”

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

“…Similarly, Hirsch et al described a significant relation between worse aortic stiffness and end-systolic volume index in patients after myocardial infarction [142]. A prospective observational study including 160 patients with first acute STEMI found that PWV measured two days after infarction using phase-contrast CMR is independently associated with an increased risk of major adverse cardiac and cerebrovascular events during a median follow-up of 1.2 years [137]. The assessment of aortic stiffness in addition to conventional risk factors significantly improved early risk classification in this study.…”

“…Although a large body of evidence has proven the prognostic implications of aortic stiffness in multiple populations, only few data exist for patients suffering a STEMI. Nevertheless, aortic stiffness has gained attention for risk prediction also in patients after STEMI [136,137]. Increased aortic stiffness as determined by aortic PWV using phase-contrast CMR has been shown to be correlated with elevated levels of natriuretic peptides and cardiac troponin in the acute and chronic stage after STEMI [138][139][140].…”

Arterial stiffness as predictive factor of cardiovascular diseases

“…The latest results showed that the increased aortic stiffness is an independent predictor of major adverse cardiac and cerebrovascular events (MACCE) after acute STelevation myocardial infarction. The assessment of aortic stiffness in addition to classical risk factors significantly improved an early risk stratification 67 .…”