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Published on: April 17, 2021
Aortic Stiffness and Infarct Healing in Survivors of Acute ST-Segment-Elevation Myocardial Infarction
Martin Reindl1, Christina Tiller1, Magdalena Holzknecht1
1University Clinic of Internal Medicine III Cardiology and Angiology Medical University of Innsbruck Austria.
Insights
Increased aortic stiffness, measured by pulse wave velocity (PWV), is linked to poorer infarct healing after ST-segment-elevation myocardial infarction (STEMI). Lower PWV predicts better recovery, highlighting a new connection between aortic stiffness and heart attack healing.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Biomedical Engineering
Background:
- Increased aortic stiffness is a known predictor of worse outcomes in ST-segment-elevation myocardial infarction (STEMI) survivors.
- The precise mechanisms linking aortic stiffness to impaired infarct healing post-STEMI remain unclear.
- This study investigates the relationship between aortic stiffness and infarct healing using cardiac magnetic resonance imaging (CMR).
Purpose of the Study:
- To assess the association between aortic stiffness, quantified by pulse wave velocity (PWV), and infarct healing in STEMI patients.
- To explore the role of CMR in evaluating infarct size reduction and its correlation with aortic stiffness.
Main Methods:
- Prospective observational study of 103 STEMI patients treated with primary percutaneous coronary intervention.
- Aortic stiffness measured using phase-contrast CMR to determine pulse wave velocity (PWV) within the first week post-STEMI.
- Infarct healing assessed by late gadolinium-enhanced CMR, defining it as relative infarct size reduction at 4-month follow-up.
Main Results:
- Median infarct size significantly decreased from 17% to 12% of left ventricular mass (P<0.001), with a median relative reduction of 36%.
- Patients achieving >36% infarct size reduction were younger, had lower baseline NT-proBNP, and lower aortic PWV values (P=0.003).
- Aortic PWV independently predicted relative infarct size reduction in multivariable logistic regression models (OR 0.64; P=0.001).
Conclusions:
- Aortic pulse wave velocity is an independent predictor of infarct size reduction in STEMI patients treated with primary PCI.
- This study reveals a novel pathophysiological link between aortic stiffness and impaired infarct healing.
- Findings suggest that aortic stiffness may influence myocardial recovery in the early phase after acute STEMI.
Abstract:
Background In survivors of acute ST-segment-elevation myocardial infarction (STEMI), increased aortic stiffness is associated with worse clinical outcome; however, the underlying pathomechanisms are incompletely understood. We aimed to investigate associations between aortic stiffness and infarct healing using comprehensive cardiac magnetic resonance imaging in patients with acute STEMI. Methods and Results This was a prospective observational study including 103 consecutive STEMI patients treated with primary percutaneous coronary intervention. Pulse wave velocity (PWV), the reference standard for aortic stiffness assessment, was determined by a validated phase-contrast cardiac magnetic resonance imaging protocol within the first week after STEMI. Infarct healing, defined as relative infarct size reduction from baseline to 4 months post-STEMI, was determined using late gadolinium-enhanced cardiac magnetic resonance. Median infarct size significantly decreased from 17% of left ventricular mass (interquartile range 9% to 28%) at baseline to 12% (6% to 17%) at 4-month follow-up (P<0.001). Relative infarct size reduction was 36% (interquartile range 15% to 52%). Patients with a reduction >36% were younger (P=0.01) and had lower baseline NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentrations (P=0.047) and aortic PWV values (P=0.003). In a continuous (odds ratio 0.64 [95% CI, 0.49-0.84]; P=0.001) as well as categorical (PWV <7 m/s; odds ratio 4.80 [95% CI, 1.89-12.20]; P=0.001) multivariable logistic regression model, the relation between aortic PWV and relative infarct size reduction remained significant after adjustment for baseline infarct size, age, NT-proBNP, and C-reactive protein. Conclusions Aortic PWV independently predicted infarct size reduction as assessed by cardiac magnetic resonance, revealing a novel pathophysiological link between aortic stiffness and adverse infarct healing during the early phase after STEMI treated with contemporary primary percutaneous coronary intervention.
