Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction

Verma, Anil; Meris, Alessandra; Skali, Hicham; Ghali, Jalal K.; Arnold, J. Malcolm O.; Bourgoun, Mikhail; Velázquez, Eric J.; McMurray, John J.V.; Køber, Lars; Pfeffer, Marc A.; Califf, Robert M.; Solomon, Scott D.

doi:10.1016/j.jcmg.2008.05.012

Cited by 242 publications

(99 citation statements)

References 34 publications

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“…However, the findings by Małek et al were limited by a small number of patients (n=52), the lack of multivariable analyses despite important differences in baseline variables between LVH and normotrophic patients, and missing measurements of MVO, area at risk, and salvage index. In contrast to our and previous observations,6 Małek et al did not report any difference in LVEF. The importance of measuring area at risk in addition to infarct size has previously been emphasized given that area at risk has an impact on infarct size 30.…”

Section: Discussioncontrasting

confidence: 99%

“…Despite the presence of LVH in approximately one third of patients with MI,6 the causal association between LVH and impaired outcome in patients with ST‐segment elevation myocardial infarction (STEMI) remains unknown. Experimental studies have demonstrated that animals with LVH have less myocardial salvage and larger infarct size following ischemia‐reperfusion 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

“…The utility of this subclassification has previously been demonstrated by significant differences in outcomes between patients with eccentric and concentric LVH 1, 5, 6. However, there are no data regarding the relationship between these subgroups and the extent of post‐MI myocardial damage.…”

Section: Introductionmentioning

confidence: 99%

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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 Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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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.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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 Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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“…Another analysis from 5098 subjects in the Multi‐Ethnic‐Study of Atherosclerosis (MESA) showed LV geometry based on cardiac MRI was a better predictor of stroke and coronary heart disease compared to LV mass alone 22. Similar associations were reported in several other disease populations, such as those with CAD,17 post–myocardial infarction,23 atrial fibrillation,24 hypertension,15, 25, 26, 27, 28 CKD,27 preserved LV function,28, 29, 30 and advanced age 31. However, most recently an analysis among patients with LVEF ≤30% enrolled in the MADIT‐CRT study found the magnitude of eccentric remodeling to be predictive of risk of recurrent ventricular arrhythmias 18.…”

Section: Discussionmentioning

confidence: 66%

Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction

Phan

Aro

Reinier

et al. 2016

JAHA

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BackgroundRecent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter‐defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.Methods and ResultsAdult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08–4.29, P=0.03).ConclusionsEccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device‐implanted and non‐implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.

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“…In that study, the odds ratio for incident cardiovascular disease in patients with concentric LVH compared with those with normal geometry was 1.3 (95% CI, 0.8–2.1) in men and 1.2 (95% CI, 0.6–2.3) in women after controlling for LVM and other cardiovascular risk factors 8. In contrast, LVM and relative wall thickness were independent predictors of all‐cause death, cardiovascular death, and hospitalization for heart failure in patients with acute myocardial infarction included in the VALIANT (Valsartan in Acute Myocardial Infarction) echocardiographic study 29. Partially different findings have been reported by Huang and coworkers in a patient population with coronary artery disease undergoing coronary angiography 30.…”

Section: Discussionmentioning

confidence: 95%

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Verdecchia¹,

Angeli

Bartolini³

et al. 2017

JAHA

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BackgroundThe different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear.Methods and ResultsWe studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24‐hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow‐up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient‐years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log‐rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24‐hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model.ConclusionsIn initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.

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Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction

Cited by 242 publications

References 34 publications

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

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

Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

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