Abstract 544: Prognostic Implications of Left Ventricular Mass and Geometry Following a First ST-Elevation Acute Myocardial Infarction
Left ventricular (LV) hypertrophy and alterations in LV geometry (Concentric LV hypertrophy and higher relative wall thickness: RWT) are associated with an increased risk of adverse events in a high risk acute myocardial infarction (AMI) from VALIANT echocardiography study (JACC Img 2008;1:582). However, the role of LV hypertrophy and RWT on a first ST-elevation AMI (STEMI) remains unclear. The aim of our study was to explore the impact of LV hypertrophy and geometry on a first reperfused STEMI exclusively involved. 278 consecutive STEMI patients (age = 64 ± 12years, male = 222, LMT = 5, LAD = 126, RCA = 115, LCx = 32) underwent echocardiography 2 weeks later and were followed for 36months. They underwent PCI successfully within 12 hours of onset. Patients with non-STEMI, A–C bypass, atrial fibrillation, and chronic renal failure on dialysis were excluded. LV mass index (LVMi) and RWT were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). A cut-off value of LVMi was defined as 130g/m2 and RWT as 0.45. Primary end point was a major adverse cardiac/cerebrovascular event (MACCE: death from cardiovascular disease, ACS, readmission because of heart failure, stroke). MACCE was occurred in 49 patients within 36months (2 death, 21heart failure,18 ACS, 5 stroke, 3 arrhythmia). Eccentric hypertrophy was only an independent predictor of deterioration of renal function (eGFR decreased from baseline >20%) (Odds ratio=4.12, 95%CI: 1.81–10.8, p<0.01) and MACCE (Odds Ratio=2.99, 95% CI: 1.23 to 7.27, p<0.01). This might be explained by the fact that eccentric hypertrophy stimulates renin-angiotensin-aldosterone system in LV remodeling strongly. RWT did not associate with deterioration of renal function or MACCE (Odds ratio=0.23, 0.31). Eccentric LV hypertrophy carries the greatest risk of MACCE among a first STEMI. RWT did not associate with an increased risk of cardiovascular complications among the patients with a first reperfused STEMI successfully.