Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction
| Autor: | Boris Bigalke, J L Navarra, Johannes T. Kowallick, Ingo Eitel, Sören J. Backhaus, Johannes Uhlig, Matthias Gutberlet, Shelby Kutty, Holger Thiele, Andreas Schuster, Alexander Koschalka, Joachim Lotz, Thomas Stiermaier, Torben Lange, Gerd Hasenfuß |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Endpoint Determination Heart Ventricles Diastole Magnetic Resonance Imaging Cine 030204 cardiovascular system & hematology Contractility 03 medical and health sciences Sex Factors 0302 clinical medicine Risk Factors Internal medicine Myocardial Revascularization medicine Clinical endpoint Humans Ventricular Function Heart Atria cardiovascular diseases 030212 general & internal medicine Myocardial infarction Aged Heart Failure Diastolic Ejection fraction medicine.diagnostic_test business.industry Confounding Magnetic resonance imaging Organ Size Middle Aged Atrial Function medicine.disease Biomechanical Phenomena Echocardiography cardiovascular system Cardiology ST Elevation Myocardial Infarction Female Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | International Journal of Cardiology. 299:31-36 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2019.06.036 |
| Popis: | Sex-specific outcome data following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse cardiac events (MACE). Since mechanistic principles remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.In total, 795 ST-elevation MI patients underwent post-interventional CMR imaging. Feature-tracking (CMR-FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster-pump strains (εa). Tissue characterisation included infarct size, microvascular obstruction and area at risk. Primary endpoint was the occurrence of MACE within 1 year.Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13-3.42, p = 0.017) but not independently of baseline confounders (p = 0.526) with women being older, more often diabetic and hypertensive (p 0.001) and of higher Killip-class (p = 0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p = 0.011, εe p 0.001) but increased systolic ventricular mechanics (GLS p = 0.001, LVEF p = 0.048). While atrial and ventricular function predicted MACE in men only LV GLS and GCS were associated with MACE in women irrespective of confounders (GLS p = 0.036, GCS p = 0.04).In men ventricular systolic contractility is impaired and volume assessments precisely stratify elevated risks. In contrast, women experience reduced atrial but increased ventricular systolic strain. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE adding incremental value to sex-specific prognosis evaluation. |
| Databáze: | OpenAIRE |
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