Eccentric hypertrophy predicts adverse events in patients undergoing percutaneous coronary intervention for acute
Edward T Ha1, Marc Cohen2,3, Stephen J Peterson1,4
1Department of Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Insights
Eccentric hypertrophy in patients with acute coronary syndrome undergoing PCI predicts worse outcomes. This type of left ventricular hypertrophy is linked to increased risks of death and major adverse cardiac events within one year.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- The prognostic impact of left ventricular hypertrophy (LVH) types in acute coronary syndrome (ACS) patients post-percutaneous coronary intervention (PCI) remains unclear.
- Understanding the differential outcomes associated with concentric hypertrophy (CH) versus eccentric hypertrophy (EH) is crucial for risk stratification.
Purpose of the Study:
- To evaluate the prognostic significance of CH and EH on adverse outcomes in ACS patients treated with PCI.
- To determine if LVH type independently predicts major adverse cardiac events (MACE) in this population.
Main Methods:
- Retrospective analysis of 1,153 ACS patients undergoing PCI with available echocardiographic data.
- 1-year follow-up data was used to assess primary endpoints including all-cause death and MACE.
- Statistical analysis identified predictors of MACE, including LVH type, age, gender, diabetes, troponin levels, and ejection fraction.
Main Results:
- Eccentric hypertrophy (EH) was present in 10.5% of patients, concentric hypertrophy (CH) in 27.2%, and normal geometry in 62.3%.
- Patients with EH had significantly higher rates of all-cause death (14.9%) and MACE (30.6%) compared to CH (8.0%, 17.8%) and normal geometry (6.4%, 13.9%).
- EH was identified as an independent predictor of MACE (HR=1.58, p=0.047).
Conclusions:
- Eccentric hypertrophy is an independent predictor of adverse cardiovascular outcomes in patients with ACS undergoing PCI.
- Risk stratification for ACS patients should consider the specific type of left ventricular hypertrophy.
- Further research may explore targeted therapies for patients with EH presenting with ACS.
Introduction:
The effect of the type of left ventricular hypertrophy in patients presenting with an acute coronary syndrome (ACS) on long-term outcomes is ill-defined. The purpose of this study was to investigate the prognostic effect of concentric (CH) or eccentric hypertrophy (EH) on adverse outcomes in patients presenting with ACS undergoing percutaneous coronary intervention (PCI).
Material And Methods:
We analyzed 1-year follow-up data from a single-institution, retrospective, observational study that enrolled 1,153 patients who presented with ACS and were treated with PCI, for whom echocardiographic data were available.
Results:
Normal geometry was observed in 718 (62.3%) patients, while 27.2% had CH and 10.5% had EH. The primary endpoint of all-cause death (n = 90, 7.8%) occurred in 6.4%, 8.0%, and 14.9% of patients with no, concentric, or eccentric hypertrophy, respectively (p = 0.005). Major adverse cardiac events (MACE - all-cause death, non-fatal myocardial infarction or stroke or hospitalization for bleeding) occurred in 13.9%, 17.8%, 30.6%, respectively (p < 0.001). Age (HR per year = 1.04 (1.02, 1.05), p < 0.001), female gender (HR = 1.56 (1.12, 2.16), p = 0.008), diabetes (HR = 1.49 (1.07, 2.06), p = 0.02), eccentric hypertrophy (HR = 1.58 (1.006, 2.47), p = 0.047), peak troponin I (HR per 1 ng/ml = 1.004 (1.001, 1.006), p = 0.004) and left ventricular ejection fraction < 50% (HR = 1.57 (1.12, 2.20), p < 0.008) were significant predictors of MACE.
Conclusions:
The presence of eccentric hypertrophy in ACS patients undergoing PCI is an independent predictor of adverse outcomes at 1 year.
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