Abstract
Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. The primary endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT-derived quantification of RA strain.
Highlights
Cardiovascular disease, and especially myocardial infarction, are of significant clinical importance [1,2]
The STEMI cohort taken from the AIDA STEMI (Abciximab Intracoronary versus intravenously Drug Application in STEMI) trial registered on ClinicalTrials.gov under NCT00712101 [26], and secondly, the NSTEMI cohort taken from the TATORT-NSTEMI (Thrombus Aspiration in Thrombus Containing Culprit Lesions in Non–ST-Elevation) trial registered with ClinicalTrials.gov under NCT01612312 [27]
Patients with predefined major adverse cardiac events (MACE) were significantly older (p < 0.001), suffered more frequently from hypertension (p = 0.019), and smoking was less common amongst them (p = 0.039)
Summary
Cardiovascular disease, and especially myocardial infarction, are of significant clinical importance [1,2]. Beyond LV functional analyses, associations of left atrial involvement and cardiovascular diseases [9], as well as mortality [10], have been established following acute myocardial infarction (AMI) [11] and in heart failure with both preserved and reduced LVEF [12]. Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be assessed using CMR-FT-derived quantification of RA strain
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