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Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction

Session Innovations in CMR for coronary artery disease

Speaker Soeren Jan Backhaus

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Deformation Imaging
  • Session type : Moderated Posters

Authors : SJ Backhaus (Goettingen,DE), JT Kowallick (Göttingen,DE), T Stiermaier (Lübeck,DE), T Lange (Goettingen,DE), A Koschalka (Goettingen,DE), JL Navarra (Goettingen,DE), J Lotz (Göttingen,DE), S Kutty (Omaha,US), B Bigalke (Berlin,DE), M Gutberlet (Leipzig,DE), G Hasenfuss (Goettingen,DE), H Thiele (Leipzig,DE), I Eitel (Lübeck,DE), A Schuster (Goettingen,DE)

Authors:
SJ Backhaus1 , JT Kowallick2 , T Stiermaier3 , T Lange1 , A Koschalka1 , JL Navarra1 , J Lotz2 , S Kutty4 , B Bigalke5 , M Gutberlet6 , G Hasenfuss1 , H Thiele7 , I Eitel3 , A Schuster1 , 1Heart Centre Goettingen - Goettingen - Germany , 2University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology - Göttingen - Germany , 3Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) - Lübeck - Germany , 4Children's Hospital and Medical Center - Omaha - United States of America , 5Charite - Campus Benjamin Franklin, Department of Cardiology - Berlin - Germany , 6Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology - Leipzig - Germany , 7Heart Center of Leipzig - Leipzig - Germany ,

Citation:

Background:
Data on sex-specific outcomes following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse clinical events (MACE). Since underlying mechanisms remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.

Methods:
Amongst 8 centres across Germany, 795 ST-elevation MI (STEMI) patients underwent post-interventional CMR imaging. CMR feature-tracking (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 (es), conduit (ee) and booster pump function (ea). Tissue characterisation included infarct size (IS), microvascular obstruction (MO), area at risk and myocardial salvage index (MSI). Primary endpoint was the occurrence of major adverse clinical events (MACE) within 1 year.

Results:
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 (es p=0.011, ee p<0.001) but increased systolic ventricular mechanics (GLS p=0.001, LVEF p=0.048). Ventricular strain was associated with MACE irrespective of all univariate significant baseline characteristics (GLS HR 1.08, 95% CI 1.01-1.16, p=0.036 and GCS HR 1.07, 95% CI 1.00-1.14, p=0.040).

Conclusion:
Atrial function is reduced in women following STEMI, while ventricular systolic function is increased. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE and may add to sex-specific prognosis evaluation.

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