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

Sören J. Backhaus; Johannes T. Kowallick; Thomas Stiermaier; Torben Lange; Alexander Koschalka; Jenny Lou Navarra; Johannes Uhlig; Joachim Lotz; Shelby Kutty; Boris Bigalke; Matthias Gutberlet; Gerd Hasenfuß; Holger Thiele; Ingo Eitel; Andreas Schuster

doi:10.1016/j.ijcard.2019.06.036

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

Sören J. Backhaus, Johannes T. Kowallick, Thomas Stiermaier, Torben Lange, Alexander Koschalka, Jenny Lou Navarra, Johannes Uhlig, Joachim Lotz, Shelby Kutty, Boris Bigalke, Matthias Gutberlet, Gerd Hasenfuß, Holger Thiele, Ingo Eitel, Andreas Schuster^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

Abstract

BACKGROUND: 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.

METHODS: 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.

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 (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).

CONCLUSION: 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.

Original language	English
Journal	International Journal of Cardiology
Volume	299
Pages (from-to)	31-36
Number of pages	6
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2019.06.036
Publication status	Published - 15.01.2020

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Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijcard.2019.06.036

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Backhaus, S. J., Kowallick, J. T., Stiermaier, T., Lange, T., Koschalka, A., Navarra, J. L., Uhlig, J., Lotz, J., Kutty, S., Bigalke, B., Gutberlet, M., Hasenfuß, G., Thiele, H., Eitel, I., & Schuster, A. (2020). Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction. International Journal of Cardiology, 299, 31-36. https://doi.org/10.1016/j.ijcard.2019.06.036

@article{cf7d1997a7474ae08148e83442e16ca8,

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

abstract = "BACKGROUND: 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.METHODS: 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.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 (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).CONCLUSION: 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.",

author = "Backhaus, {S{\"o}ren J.} and Kowallick, {Johannes T.} and Thomas Stiermaier and Torben Lange and Alexander Koschalka and Navarra, {Jenny Lou} and Johannes Uhlig and Joachim Lotz and Shelby Kutty and Boris Bigalke and Matthias Gutberlet and Gerd Hasenfu{\ss} and Holger Thiele and Ingo Eitel and Andreas Schuster",

note = "Funding Information: The study population consisted of ST-elevation MI (STEMI) patients enrolled within the AIDA STEMI trial (Abciximab Intracoronary versus Intravenously Drug Application in STEMI, NCT00712101 ) [ 21 ]. The trial was conducted amongst 22 centres across Germany, randomizing 2065 patients to treatment either by intracoronary (n = 1032) or intravenous (n = 1033) abciximab bolus application (0.25 mg/kg bodyweight) during primary percutaneous coronary intervention (PCI) which was then followed by continuous intravenous infusion for 12 h (0.125 μg/kg/min, max. 10 μg/min). Amongst 8 study sites chosen for their expertise in cardiovascular imaging, 795 patients underwent additional CMR imaging after PCI. The study was approved by the lead ethical committee at the University of Leipzig and all local ethical committees of involved study sites. All patients gave written informed consent before randomization. The studies were conducted according to the principles of the Helsinki Declaration. The CMR sub-study was supported by a German Centre for Cardiovascular Research (DZHK) research grant. Funding Information: We thank the German Centre for Cardiovascular Research (DZHK) for funding of the study. Publisher Copyright: {\textcopyright} 2019 Elsevier B.V. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

year = "2020",

month = jan,

day = "15",

doi = "10.1016/j.ijcard.2019.06.036",

language = "English",

volume = "299",

pages = "31--36",

journal = "International Journal of Cardiology",

issn = "0167-5273",

}

Backhaus, SJ, Kowallick, JT, Stiermaier, T, Lange, T, Koschalka, A, Navarra, JL, Uhlig, J, Lotz, J, Kutty, S, Bigalke, B, Gutberlet, M, Hasenfuß, G, Thiele, H, Eitel, I & Schuster, A 2020, 'Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction', International Journal of Cardiology, vol. 299, pp. 31-36. https://doi.org/10.1016/j.ijcard.2019.06.036

TY - JOUR

T1 - Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction

AU - Backhaus, Sören J.

AU - Kowallick, Johannes T.

AU - Stiermaier, Thomas

AU - Lange, Torben

AU - Koschalka, Alexander

AU - Navarra, Jenny Lou

AU - Uhlig, Johannes

AU - Lotz, Joachim

AU - Kutty, Shelby

AU - Bigalke, Boris

AU - Gutberlet, Matthias

AU - Hasenfuß, Gerd

AU - Thiele, Holger

AU - Eitel, Ingo

AU - Schuster, Andreas

N1 - Funding Information: The study population consisted of ST-elevation MI (STEMI) patients enrolled within the AIDA STEMI trial (Abciximab Intracoronary versus Intravenously Drug Application in STEMI, NCT00712101 ) [ 21 ]. The trial was conducted amongst 22 centres across Germany, randomizing 2065 patients to treatment either by intracoronary (n = 1032) or intravenous (n = 1033) abciximab bolus application (0.25 mg/kg bodyweight) during primary percutaneous coronary intervention (PCI) which was then followed by continuous intravenous infusion for 12 h (0.125 μg/kg/min, max. 10 μg/min). Amongst 8 study sites chosen for their expertise in cardiovascular imaging, 795 patients underwent additional CMR imaging after PCI. The study was approved by the lead ethical committee at the University of Leipzig and all local ethical committees of involved study sites. All patients gave written informed consent before randomization. The studies were conducted according to the principles of the Helsinki Declaration. The CMR sub-study was supported by a German Centre for Cardiovascular Research (DZHK) research grant. Funding Information: We thank the German Centre for Cardiovascular Research (DZHK) for funding of the study. Publisher Copyright: © 2019 Elsevier B.V. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2020/1/15

Y1 - 2020/1/15

N2 - BACKGROUND: 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.METHODS: 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.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 (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).CONCLUSION: 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.

AB - BACKGROUND: 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.METHODS: 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.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 (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).CONCLUSION: 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.

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DO - 10.1016/j.ijcard.2019.06.036

M3 - Journal articles

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VL - 299

SP - 31

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JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

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

Abstract

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