Prognostic Value of Aortic Stiffness in Patients After ST-Elevation Myocardial Infarction - PubMed (original) (raw)

Observational Study

Prognostic Value of Aortic Stiffness in Patients After ST-Elevation Myocardial Infarction

Hans-Josef Feistritzer et al. J Am Heart Assoc. 2017.

Abstract

Background: High aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST-elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far.

Methods and results: This prospective observational study included 160 consecutive patients with first acute ST-elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2-4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow-up of 1.2 years (interquartile range 1.0-3.1 years), 19 (12%) MACCE events occurred. Kaplan-Meier analysis showed a significantly lower MACCE-free survival in patients with high PWV (PWV >7.3 m/s, log-rank _P_=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N-terminal pro-brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4-13.3; all _P_≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06-0.17; P<0.001).

Conclusions: Increased aortic stiffness is an independent predictor of MACCE after acute ST-elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification.

Keywords: ST‐elevation myocardial infarction; aortic stiffness; cardiac magnetic resonance; prognosis; pulse wave velocity.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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Figures

Figure 1

Figure 1

Flow diagram of the study cohort.

CMR

indicates cardiac magnetic resonance;

MACCE

, major adverse cardiac and cerebrovascular events;

PWV

, pulse wave velocity.

Figure 2

Figure 2

Assessment of aortic pulse wave velocity. Blood flow was measured at the level of the ascending (

aA

) and abdominal (abdA) aorta. Distance between those levels was measured along the luminal midline of the aorta on an oblique sagittal slice.

aA

indicates ascending aorta; abdA, abdominal aorta.

Figure 3

Figure 3

Linear correlation between

PWV

and age (A) and

NT

‐pro

BNP

concentrations (B).

NT

‐pro

BNP

indicates N‐terminal pro‐B‐type natriuretic peptide;

PWV

, pulse wave velocity.

Figure 4

Figure 4

ROC

analysis of

PWV

(

AUC

=0.68, 95%

CI

0.56‐0.79), age (

AUC

=0.74, 95%

CI

0.63‐0.85), mean

BP

(

AUC

=0.51, 95%

CI

0.34‐0.68), peak

NT

‐pro

BNP

concentrations (

AUC

=0.71, 95%

CI

0.58‐0.84), and

LVSV

(

AUC

=0.78, 95%

CI

0.68‐0.87) for the prediction of

MACCE

.

AUC

indicates area under the curve;

BP

, blood pressure; CI, confidence interval;

LVSV

, left ventricular stroke volume;

MACCE

, major adverse cardiac and cerebrovascular events;

NT

‐pro

BNP

, N‐terminal pro‐B‐type natriuretic peptide;

PWV

, pulse wave velocity;

ROC

, receiver operating characteristics.

Figure 5

Figure 5

Numbers of

MACCE

in patients with

PWV

above and below 7.3 m/s.

MACCE

indicates major adverse cardiac and cerebrovascular events;

PWV

, pulse wave velocity.

Figure 6

Figure 6

Kaplan‐Meier curves for the occurrence of

MACCE

stratified by

PWV

.

PWV

was calculated by

ROC

analysis.

MACCE

indicates major adverse cardiac and cerebrovascular events;

PWV

, pulse wave velocity;

ROC

, receiver operating characteristics.

Figure 7

Figure 7

Number of new congestive heart failure (A), stroke (B), myocardial reinfarction (C), and death (D) incidents in patients with

PWV

above and below 7.3 m/s.

HF

indicates heart failure;

PWV

, pulse wave velocity.

References

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