Association of left ventricular geometry early after an acute coronary syndrome to long-term mortality

Abstract

Abstract Background Markers of adverse left ventricular remodelling following myocardial infarction are associated with an increased risk of adverse events. Remodelling patterns can be classified using left ventricular mass index (LVMI) and relative wall thickness (RWT) into normal geometry, eccentric hypertrophy, concentric remodelling and concentric hypertrophy. In this analysis we evaluated the association between geometric classifications early after an acute coronary syndrome (ACS) and longer-term survival. Methods The Coronary Disease Cohort Study is a prospective multicentre observational cohort study. Between 2002-2010, 2140 ACS patients were recruited across New Zealand. Echocardiography and blood biomarker sampling were obtained at 1, 4 and 12 months of follow-up after ACS. Echocardiographic data from 1 month after ACS were analysed and patients classified into 4 groups based on geometry. The relationship between geometry and mortality at a median of 14 years follow up were evaluated using cox proportional hazards models after adjusting for demographics, clinical characteristics and biomarkers. Results Of 2140 patients, 401 (19%) had normal geometry, 747 (35%) concentric hypertrophy, 569 (26.5%) eccentric remodelling, 153 (7.1%) concentric remodelling, and 271 (12.7%) had incomplete data to classify. 874/2055 (43%) of participants had died at most recent follow up in 2022. Compared to those with normal geometry, the risk of death for patients with abnormal geometry was increased: concentric hypertrophy (hazard ratio [HR]:2.1; 95% confidence interval [CI]: 1.6 – 2.9); eccentric hypertrophy (HR: 1.7; 94% CI :1.3 – 2.4); concentric remodelling (HR: 1.7; 95% CI :1.1 – 2.6) after adjusting for baseline demographic, clinical, and biomarker covariates. Conclusion Abnormal left ventricular geometry documented one month after ACS portends an increased risk of death. Concentric hypertrophy carried the highest risk of death at long-term follow up.Unadjusted survival curves