Determinants and prognostic relevance of aortic stiffness in patients with recent ST-elevation myocardial infarction.
Ivan LechnerMartin ReindlChristina TillerMagdalena HolzknechtSarah NiederreiterAgnes MayrGert KlugChristoph BrennerAxel BauerBernhard MetzlerSebastian Johannes ReinstadlerPublished in: The international journal of cardiovascular imaging (2021)
The association between aortic stiffness, cardiovascular risk factors and prognosis in patients with recent ST-elevation myocardial infarction (STEMI) is poorly understood. We analyzed the relationship between cardiovascular risk factors and arterial stiffening and assessed its prognostic significance in patients with recent STEMI. We prospectively enrolled 408 consecutive patients who sustained a first STEMI and underwent primary percutaneous coronary intervention (PPCI). Aortic pulse wave velocity (PWV), the most widely used measure of aortic stiffness, was determined by the transit-time method using velocity-encoded, phase-contrast cardiac magnetic resonance imaging. Patient characteristics were acquired at baseline and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 13 [interquartile range (IQR) 12-31] months. Cox regression- and logistic regression analysis were performed to explore predictors of aortic stiffness and MACCE. Median aortic PWV was 6.6 m/s (IQR 5.6-8.3 m/s). In multivariable analysis, age [odds ratio (OR) 1.10, 95% confidence interval (CI), 1.08-1.14, p < 0.001] and hypertension (OR 2.45, 95% CI, 1.53-3.91, p < 0.001) were independently associated with increased PWV. Sex, diabetes, smoking status, dyslipidemia, and obesity were not significantly associated with PWV in adjusted analysis (all p > 0.05). High PWV significantly and independently predicted occurrence of MACCE in adjusted analysis [hazard ratio (HR) 2.45, 95% CI 1.19-5.04, p = 0.014]. In patients with recent STEMI, the impact of classical cardiovascular risk factors on aortic stiffness is mainly dependent on age and increased blood pressure. Increased aortic stiffness is associated with adverse clinical outcome post-STEMI, suggesting it as a relevant therapeutic target in this population. Trial (NCT04113356).
Keyphrases
- st elevation myocardial infarction
- percutaneous coronary intervention
- cardiovascular risk factors
- aortic valve
- left ventricular
- st segment elevation myocardial infarction
- blood pressure
- pulmonary artery
- coronary artery disease
- acute myocardial infarction
- magnetic resonance imaging
- acute coronary syndrome
- cardiovascular disease
- antiplatelet therapy
- metabolic syndrome
- coronary artery bypass grafting
- aortic dissection
- type diabetes
- computed tomography
- atrial fibrillation
- insulin resistance
- study protocol
- clinical trial
- heart failure
- magnetic resonance
- pulmonary hypertension
- adipose tissue
- risk assessment
- case report
- data analysis
- hypertensive patients
- glycemic control
- placebo controlled
- phase ii