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Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial
E Carluccio1, S Tommasi, M Bentivoglio
1Department of Clinical and Experimental Medicine, Division of Cardiology, Policlinico Monteluce, University of Perugia, Via Brunamonti, 1, 06100 Perugia, Italy.
Insights
Left ventricular hypertrophy and concentric geometry predict poor cardiovascular outcomes in patients recovering from acute myocardial infarction (AMI) with preserved ejection fraction. These findings highlight key risk factors for adverse events post-AMI.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Risk Stratification
Background:
- Prognostic impact of left ventricular (LV) geometry in first acute myocardial infarction (AMI) patients with preserved ejection fraction (> or =50%) is not well-defined.
- Understanding LV geometry's role is crucial for risk stratification in post-AMI care.
Purpose of the Study:
- To investigate the prognostic significance of LV geometry and mass on cardiovascular risk in patients with a first, uncomplicated AMI and preserved LV ejection fraction.
- To identify specific LV geometric patterns associated with adverse cardiac events.
Main Methods:
- Echocardiographic examination performed at predischarge in 111 consecutive AMI patients.
- Left ventricular (LV) mass indexed by body surface area using Devereux's formula.
- Follow-up assessment for cardiac events including cardiac death, unstable angina, and non-fatal reinfarction.
Main Results:
- 53 patients had LV hypertrophy, 58 had normal LV mass; groups were comparable demographically and clinically.
- Patients with LV hypertrophy experienced significantly more cardiac events (24 vs. 4, RR=2.45, P<0.0001).
- Concentric LV hypertrophy was associated with a higher event incidence (64%) compared to eccentric (32%) and normal geometry (6%). Concentric geometry emerged as the strongest predictor of adverse outcomes.
Conclusions:
- Increased LV mass and concentric geometry are significant independent predictors of adverse outcomes in patients post-AMI with preserved LV function.
- Echocardiographic assessment of LV geometry provides valuable prognostic information for risk-stratifying AMI survivors.
- Targeting LV geometry abnormalities may offer therapeutic opportunities to improve outcomes in this patient population.
Background:
The prognostic impact of left ventricular (LV) geometry on cardiovascular risk for patients with a first, uncomplicated acute myocardial infarction (AMI), and echocardiographic ejection fraction > or =50% has not been well described.
Methods And Results:
Accordingly, 111 AMI consecutive patients (mean age 59.3+/-10 years) performed echocardiographic examination at predischarge. LV mass was calculated by means of Devereux's formula and subsequently indexed by body surface area. Fifty-three patients had LV hypertrophy and 58 patients had normal LV mass. The two groups were homogeneous for demographic, clinical and angiographic variables as well as for the incidence of residual ischemia on predischarge stress testing. During follow-up period there were 24 cardiac events (cardiac death, unstable angina and non-fatal reinfarction) in the 53 patients with LV hypertrophy and only four events in the remaining 58 patients without LV hypertrophy (RR=2.45; CI=1.76-3.41; P<0.0001). The patients with concentric LV hypertrophy showed a higher incidence of events (64%) than patients with eccentric LV hypertrophy (32%, P<0. 05) and patients with normal geometry and mass (6%, P<0.0001). Multivariate Cox regression model identified concentric geometry as the most powerful predictor of combined end-points (chi(2)=32.7, P<0. 0001).
Conclusions:
An increased LV mass and concentric geometry resulted important independent markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction and good LV function.
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