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16-01-2017 | Acute coronary syndromes | News | Article

Left ventricular hypertrophy could increase tissue damage during STEMI

medwireNews: A substudy of the DANAMI-3 trial suggests that adverse outcomes associated with left ventricular hypertrophy (LVH) among patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention could be mediated by increased myocardial damage.

Lars Nepper-Christensen and fellow researchers found that LVH – defined as left ventricular (LV) mass exceeding 77 g/m2 in men and 67 g/m2 in women – occurred in 24% of 764 trial participants included in the cardiovascular magnetic resonance substudy.

Patients with LVH had a larger acute and final infarct size than normotrophic patients, at 22% versus 13% of LV mass and 15% versus 9% of LV mass, respectively. The area at risk was also higher among patients with LVH (36 vs 32% of LV mass).

After adjustment for area at risk, the association between LVH and infarct size remained significant, suggesting “that patients with LVH developed significantly larger infarcts for an equivalent area at risk,” report the authors in the Journal of the American Heart Association.

Furthermore, myocardial salvage indices and LV ejection fraction were lower among patients with LVH compared with normotrophic patients, associations that remained significant after adjustment for factors including gender, body mass index, blood pressure, and prior cardiovascular disease, as did the link between larger infarct sizes and LVH.

And LVH was associated with a significant 2.52-fold increased risk for all-cause mortality and readmission for heart failure after multivariable adjustment. However, the difference was no longer significant when the authors adjusted for acute infarct size.

Together, these findings suggest that “the impaired prognosis in patients with acute MI and LVH may directly be attributed to more-extensive myocardial damage and smaller salvage,” say the authors.

They add that the results could suggest “a causal relationship between LVH and increased myocardial damage,” but caution that information on potentially confounding factors such as medication usage at admission and hypertension severity was not available.

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2017

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