Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction

Sören J. Backhaus, Johannes T. Kowallick, Thomas Stiermaier, Torben Lange, Alexander Koschalka, Jenny Lou Navarra, Joachim Lotz, Shelby Kutty, Boris Bigalke, Matthias Gutberlet, Hans Josef Feistritzer, Gerd Hasenfuß, Holger Thiele, Andreas Schuster, Ingo Eitel

Research output: Contribution to journalArticle

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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 Graphic abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
JournalClinical Research in Cardiology
DOIs
StatePublished - Jan 1 2019

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Mechanics
Coronary Vessels
Magnetic Resonance Spectroscopy
Myocardial Infarction
Arteries
Area Under Curve
Percutaneous Coronary Intervention
Stroke Volume
Myocardium
Multivariate Analysis
Mortality
Therapeutics

Keywords

  • Cardiac function
  • Cardiovascular magnetic resonance
  • Feature tracking
  • Infarct-related artery
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction. / Backhaus, Sören J.; Kowallick, Johannes T.; Stiermaier, Thomas; Lange, Torben; Koschalka, Alexander; Navarra, Jenny Lou; Lotz, Joachim; Kutty, Shelby; Bigalke, Boris; Gutberlet, Matthias; Feistritzer, Hans Josef; Hasenfuß, Gerd; Thiele, Holger; Schuster, Andreas; Eitel, Ingo.

In: Clinical Research in Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Backhaus, SJ, Kowallick, JT, Stiermaier, T, Lange, T, Koschalka, A, Navarra, JL, Lotz, J, Kutty, S, Bigalke, B, Gutberlet, M, Feistritzer, HJ, Hasenfuß, G, Thiele, H, Schuster, A & Eitel, I 2019, 'Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction', Clinical Research in Cardiology. https://doi.org/10.1007/s00392-019-01514-x
Backhaus, Sören J. ; Kowallick, Johannes T. ; Stiermaier, Thomas ; Lange, Torben ; Koschalka, Alexander ; Navarra, Jenny Lou ; Lotz, Joachim ; Kutty, Shelby ; Bigalke, Boris ; Gutberlet, Matthias ; Feistritzer, Hans Josef ; Hasenfuß, Gerd ; Thiele, Holger ; Schuster, Andreas ; Eitel, Ingo. / Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction. In: Clinical Research in Cardiology. 2019.
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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 Graphic abstract: [Figure not available: see fulltext.].",
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T1 - Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction

AU - Backhaus, Sören J.

AU - Kowallick, Johannes T.

AU - Stiermaier, Thomas

AU - Lange, Torben

AU - Koschalka, Alexander

AU - Navarra, Jenny Lou

AU - Lotz, Joachim

AU - Kutty, Shelby

AU - Bigalke, Boris

AU - Gutberlet, Matthias

AU - Feistritzer, Hans Josef

AU - Hasenfuß, Gerd

AU - Thiele, Holger

AU - Schuster, Andreas

AU - Eitel, Ingo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 Graphic abstract: [Figure not available: see fulltext.].

AB - 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 Graphic abstract: [Figure not available: see fulltext.].

KW - Cardiac function

KW - Cardiovascular magnetic resonance

KW - Feature tracking

KW - Infarct-related artery

KW - Prognosis

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