565 Impact of right atrial physiology on heart failure and adverse events after myocardial infarction
| Autor: | Holger Thiele, Ingo Eitel, Karl-Philipp Rommel, Matthias Gutberlet, Jeffrey C. Lotz, Johannes T. Kowallick, Gerd Hasenfuß, J L Navarra, T Stiermaier, Shelby Kutty, Boris Bigalke, Alexander Koschalka, Andreas Schuster, S J Backhaus |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry General Medicine 030204 cardiovascular system & hematology medicine.disease Right atrial 3. Good health 03 medical and health sciences 0302 clinical medicine Internal medicine Heart failure Cardiology medicine Radiology Nuclear Medicine and imaging cardiovascular diseases Myocardial infarction Cardiology and Cardiovascular Medicine business Adverse effect |
| Zdroj: | European Heart Journal - Cardiovascular Imaging. 21 |
| ISSN: | 2047-2412 2047-2404 |
| DOI: | 10.1093/ehjci/jez319.295 |
| Popis: | Background Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion needs further evaluation. Methods 1235 MI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation MI and 440 with non ST-elevation MI). Right atrial (RA) performance was evaluated using cardiac magnetic resonance myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa) and associated strain rates (SR) in a blinded core-laboratory. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post MI. Results RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with clinical onset of heart failure and MACE independently of RV systolic function (multi-variable analysis HR 0.95, 95% CI 0.91-0.99, p = 0.006) while RV systolic function was no independent prognosticator (HR 0.98, 95% CI 0.96-1.00, p = 0.055). Furthermore, RA conduit strain identified low- and high-risk groups within patients with relatively preserved and reduced RV and LV systolic functions (p Conclusions Right atrial impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT derived quantification of RA strain. |
| Databáze: | OpenAIRE |
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