Impact of left ventricular hypertrophy on myocardial injury in patients with ST-segment elevation myocardial infarction

  • Thomas Stiermaier
  • Janine Pöss
  • Charlotte Eitel
  • Suzanne de Waha
  • Georg Fuernau
  • Steffen Desch
  • Holger Thiele
  • Ingo Eitel
Original Paper
  • 4 Downloads

Abstract

Background

Left ventricular hypertrophy (LVH) has been suggested as a determinant of outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, available data are inconclusive and the underlying mechanisms remain unclear. Therefore, the aim of this study was to evaluate the impact of LVH on myocardial injury and clinical outcome in a large multicenter STEMI population.

Methods

Cardiovascular magnetic resonance was performed in 795 patients within 10 days after STEMI to assess left ventricular (LV) mass and parameters of myocardial injury. Gender-specific cutoff values of indexed LV mass were used to define LVH (67 g/m2 for men and 61 g/m2 for women). Rates of major adverse cardiac events (MACE) were determined at 12-month follow-up.

Results

LVH was present in 438 patients (55%) and associated with a significantly larger infarct size [18.3% of LV mass (%LV) versus 14.0%LV; p < 0.01], a lower myocardial salvage index (47.8 versus 54.4; p < 0.01), larger extent of microvascular obstruction (0.4 versus 0%LV; p < 0.01) and lower LV ejection fraction (47.9 versus 53.2%; p < 0.01) compared to STEMI patients without LVH. The effect of LVH on LV ejection fraction, infarct size and myocardial salvage index remained statistically significant after adjustment for baseline characteristics (p < 0.01 for all). MACE rates at 12 months were numerically higher in patients with versus without LVH without reaching statistical significance (7.5 versus 5.6%; p = 0.32).

Conclusion

In STEMI patients, LVH is associated with more pronounced structural and functional alterations in CMR imaging as an indicator for adverse clinical outcomes in STEMI survivors.

Keywords

ST-segment elevation myocardial infarction Cardiac magnetic resonance imaging Left ventricular hypertrophy Myocardial injury Prognosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Supplementary material

392_2018_1273_MOESM1_ESM.docx (50 kb)
Supplementary material 1 (DOCX 49 KB)

References

  1. 1.
    Di Bella G, Siciliano V, Aquaro GD, Molinaro S, Lombardi M, Carerj S, Landi P, Rovai D, Pingitore A (2013) Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification. Eur Heart J 34(2):104–111.  https://doi.org/10.1093/eurheartj/ehs037 CrossRefPubMedGoogle Scholar
  2. 2.
    Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van ‘t Hof A, Widimsky P, Zahger D (2012) ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619.  https://doi.org/10.1093/eurheartj/ehs215 CrossRefPubMedGoogle Scholar
  3. 3.
    Eitel I, de Waha S, Wohrle J, Fuernau G, Lurz P, Pauschinger M, Desch S, Schuler G, Thiele H (2014) Comprehensive prognosis assessment by CMR imaging after ST-segment elevation myocardial infarction. J Am Coll Cardiol 64(12):1217–1226.  https://doi.org/10.1016/j.jacc.2014.06.1194 CrossRefPubMedGoogle Scholar
  4. 4.
    Bluemke DA, Kronmal RA, Lima JA, Liu K, Olson J, Burke GL, Folsom AR (2008) The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (multi-ethnic study of atherosclerosis) study. J Am Coll Cardiol 52(25):2148–2155.  https://doi.org/10.1016/j.jacc.2008.09.014 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tsang TS, Barnes ME, Gersh BJ, Takemoto Y, Rosales AG, Bailey KR, Seward JB (2003) Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography. J Am Coll Cardiol 42(7):1199–1205 (pii:S0735109703009434) CrossRefPubMedGoogle Scholar
  6. 6.
    Verma A, Meris A, Skali H, Ghali JK, Arnold JM, Bourgoun M, Velazquez EJ, McMurray JJ, Kober L, Pfeffer MA, Califf RM, Solomon SD (2008) Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (valsartan in acute myocardial infarction) echocardiographic study. JACC Cardiovasc Imaging 1(5):582–591.  https://doi.org/10.1016/j.jcmg.2008.05.012 CrossRefPubMedGoogle Scholar
  7. 7.
    Carluccio E, Tommasi S, Bentivoglio M, Buccolieri M, Filippucci L, Prosciutti L, Corea L (2000) Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial infarction. Int J Cardiol 74(2–3):177–183 (pii:S0167527300002643) CrossRefPubMedGoogle Scholar
  8. 8.
    Molgaard S, Faricelli B, Salomonsson M, Engstrom T, Treiman M (2016) Increased myocardial vulnerability to ischemia-reperfusion injury in the presence of left ventricular hypertrophy. J Hypertens 34(3):513–523.  https://doi.org/10.1097/HJH.0000000000000826 (discussion 523) CrossRefPubMedGoogle Scholar
  9. 9.
    Malek LA, Spiewak M, Klopotowski M, Petryka J, Mazurkiewicz L, Kruk M, Kepka C, Misko J, Ruzyllo W, Witkowski A (2012) Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction. Eur J Radiol 81(3):e177–e181.  https://doi.org/10.1016/j.ejrad.2011.01.088 CrossRefPubMedGoogle Scholar
  10. 10.
    Fernandez-Jimenez R, Silva J, Martinez-Martinez S, Lopez-Maderuelo MD, Nuno-Ayala M, Garcia-Ruiz JM, Garcia-Alvarez A, Fernandez-Friera L, Pizarro TG, Garcia-Prieto J, Sanz-Rosa D, Lopez-Martin G, Fernandez-Ortiz A, Macaya C, Fuster V, Redondo JM, Ibanez B (2015) Impact of left ventricular hypertrophy on troponin release during acute myocardial infarction: new insights from a comprehensive translational study. J Am Heart Assoc 4(1):e001218.  https://doi.org/10.1161/JAHA.114.001218 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Thiele H, Wohrle J, Neuhaus P, Brosteanu O, Sick P, Prondzinsky R, Birkemeyer R, Wiemer M, Kerber S, Schuehlen H, Kleinertz K, Axthelm C, Zimmermann R, Rittger H, Braun-Dullaeus RC, Lauer B, Burckhardt W, Ferrari M, Bergmann MW, Hambrecht R, Schuler G (2010) Intracoronary compared with intravenous bolus abciximab application during primary percutaneous coronary intervention: design and rationale of the abciximab intracoronary versus intravenously drug application in st-elevation myocardial infarction (AIDA STEMI) trial. Am Heart J 159(4):547–554.  https://doi.org/10.1016/j.ahj.2009.12.038 CrossRefPubMedGoogle Scholar
  12. 12.
    Thiele H, Wohrle J, Hambrecht R, Rittger H, Birkemeyer R, Lauer B, Neuhaus P, Brosteanu O, Sick P, Wiemer M, Kerber S, Kleinertz K, Eitel I, Desch S, Schuler G (2012) Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet 379(9819):923–931.  https://doi.org/10.1016/S0140-6736(11)61872-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Desch S, Wohrle J, Hambrecht R, Rittger H, Birkemeyer R, Lauer B, Neuhaus P, Brosteanu O, Sick P, Pauschinger M, Kerber S, Kleinertz K, de Waha S, Eitel I, Schuler G, Thiele H (2013) Intracoronary versus intravenous abciximab bolus in patients with ST-segment elevation myocardial infarction: 1-year results of the randomized AIDA STEMI trial. J Am Coll Cardiol 62(13):1214–1215.  https://doi.org/10.1016/j.jacc.2013.06.014 CrossRefPubMedGoogle Scholar
  14. 14.
    Eitel I, Wohrle J, Suenkel H, Meissner J, Kerber S, Lauer B, Pauschinger M, Birkemeyer R, Axthelm C, Zimmermann R, Neuhaus P, Brosteanu O, de Waha S, Desch S, Gutberlet M, Schuler G, Thiele H (2013) Intracoronary compared with intravenous bolus abciximab application during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: cardiac magnetic resonance substudy of the AIDA STEMI trial. J Am Coll Cardiol 61(13):1447–1454.  https://doi.org/10.1016/j.jacc.2013.01.048 CrossRefPubMedGoogle Scholar
  15. 15.
    Thiele H, Kappl MJ, Conradi S, Niebauer J, Hambrecht R, Schuler G (2006) Reproducibility of chronic and acute infarct size measurement by delayed enhancement-magnetic resonance imaging. J Am Coll Cardiol 47(8):1641–1645.  https://doi.org/10.1016/j.jacc.2005.11.065 CrossRefPubMedGoogle Scholar
  16. 16.
    Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, Plein S, Tee M, Eng J, Bluemke DA (2015) Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 17:29.  https://doi.org/10.1186/s12968-015-0111-7 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Salton CJ, Chuang ML, O’Donnell CJ, Kupka MJ, Larson MG, Kissinger KV, Edelman RR, Levy D, Manning WJ (2002) Gender differences and normal left ventricular anatomy in an adult population free of hypertension. A cardiovascular magnetic resonance study of the Framingham Heart Study Offspring cohort. J Am Coll Cardiol 39(6):1055–1060 (pii:S0735109702017126) CrossRefPubMedGoogle Scholar
  18. 18.
    Khouri MG, Peshock RM, Ayers CR, de Lemos JA, Drazner MH (2010) A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study. Circ Cardiovasc Imaging 3(2):164–171.  https://doi.org/10.1161/CIRCIMAGING.109.883652 CrossRefPubMedGoogle Scholar
  19. 19.
    Nepper-Christensen L, Lonborg J, Ahtarovski KA, Hofsten DE, Kyhl K, Ghotbi AA, Schoos MM, Goransson C, Bertelsen L, Kober L, Helqvist S, Pedersen F, Saunamaki K, Jorgensen E, Kelbaek H, Holmvang L, Vejlstrup N, Engstrom T (2017) 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. J Am Heart Assoc.  https://doi.org/10.1161/JAHA.116.004823 PubMedPubMedCentralGoogle Scholar
  20. 20.
    Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP (1987) Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 59(9):956–960 (pii:0002-9149(87)91133-7) CrossRefPubMedGoogle Scholar
  21. 21.
    Rakusan K, Flanagan MF, Geva T, Southern J, Van Praagh R (1992) Morphometry of human coronary capillaries during normal growth and the effect of age in left ventricular pressure-overload hypertrophy. Circulation 86(1):38–46CrossRefPubMedGoogle Scholar
  22. 22.
    Eitel I, Poss J, Jobs A, Eitel C, de Waha S, Barkhausen J, Desch S, Thiele H (2015) Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction. J Cardiovasc Magn Reson 17:62.  https://doi.org/10.1186/s12968-015-0161-x CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gardin JM, McClelland R, Kitzman D, Lima JA, Bommer W, Klopfenstein HS, Wong ND, Smith VE, Gottdiener J (2001) M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the cardiovascular health study). Am J Cardiol 87(9):1051–1057 (pii:S0002-9149(01)01460-6) CrossRefPubMedGoogle Scholar
  24. 24.
    Behar S, Reicher-Reiss H, Abinader E, Agmon J, Barzilai J, Friedman Y, Kaplinsky E, Kauli N, Kishon Y, Palant A et al (1992) Long-term prognosis after acute myocardial infarction in patients with left ventricular hypertrophy on the electrocardiogram. SPRINT study group. Am J Cardiol 69(12):985–990CrossRefPubMedGoogle Scholar
  25. 25.
    Georgescu A, Fu Y, Yau C, Hassan Q, Luchansky J, Armstrong PW, Wagner G, Van de Werf F, Goodman SG, Assessment of the Safety and Efficacy of a New Thrombolytic Regimen Trial (ASSENT-III) Investigators (2005) Short- and long-term outcomes of patients with electrocardiographic left ventricular hypertrophy after fibrinolysis for acute myocardial infarction. Am J Cardiol 96(8):1050–1052.  https://doi.org/10.1016/j.amjcard.2005.06.029 CrossRefPubMedGoogle Scholar
  26. 26.
    Westerhout CM, Lauer MS, James S, Fu Y, Wallentin L, Armstrong PW, Investigators GIA (2007) Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women. Eur Heart J 28(17):2064–2069.  https://doi.org/10.1093/eurheartj/ehm223 CrossRefPubMedGoogle Scholar
  27. 27.
    Missouris CG, Forbat SM, Singer DR, Markandu ND, Underwood R, MacGregor GA (1996) Echocardiography overestimates left ventricular mass: a comparative study with magnetic resonance imaging in patients with hypertension. J Hypertens 14(8):1005–1010CrossRefPubMedGoogle Scholar
  28. 28.
    Turschner O, D’Hooge J, Dommke C, Claus P, Verbeken E, De Scheerder I, Bijnens B, Sutherland GR (2004) The sequential changes in myocardial thickness and thickening which occur during acute transmural infarction, infarct reperfusion and the resultant expression of reperfusion injury. Eur Heart J 25(9):794–803.  https://doi.org/10.1016/j.ehj.2004.01.006 CrossRefPubMedGoogle Scholar
  29. 29.
    Younger JF, Plein S, Barth J, Ridgway JP, Ball SG, Greenwood JP (2007) Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction. Heart 93(12):1547–1551.  https://doi.org/10.1136/hrt.2006.109249 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kim HW, Van Assche L, Jennings RB, Wince WB, Jensen CJ, Rehwald WG, Wendell DC, Bhatti L, Spatz DM, Parker MA, Jenista ER, Klem I, Crowley AL, Chen EL, Judd RM, Kim RJ (2015) Relationship of T2-weighted MRI myocardial hyperintensity and the ischemic area-at-risk. Circ Res 117(3):254–265.  https://doi.org/10.1161/CIRCRESAHA.117.305771 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fernandez-Jimenez R, Sanchez-Gonzalez J, Aguero J, Garcia-Prieto J, Lopez-Martin GJ, Garcia-Ruiz JM, Molina-Iracheta A, Rossello X, Fernandez-Friera L, Pizarro G, Garcia-Alvarez A, Dall’Armellina E, Macaya C, Choudhury RP, Fuster V, Ibanez B (2015) Myocardial edema after ischemia/reperfusion is not stable and follows a bimodal pattern: imaging and histological tissue characterization. J Am Coll Cardiol 65(4):315–323.  https://doi.org/10.1016/j.jacc.2014.11.004 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Thomas Stiermaier
    • 1
    • 2
  • Janine Pöss
    • 1
    • 2
  • Charlotte Eitel
    • 1
    • 2
  • Suzanne de Waha
    • 1
    • 2
  • Georg Fuernau
    • 1
    • 2
  • Steffen Desch
    • 3
  • Holger Thiele
    • 3
  • Ingo Eitel
    • 1
    • 2
  1. 1.Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)University Heart Center Lübeck, University Hospital Schleswig-HolsteinLübeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/LübeckLübeckGermany
  3. 3.Department of Internal Medicine/CardiologyHeart Center Leipzig–University HospitalLeipzigGermany

Personalised recommendations