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Latent Cytomegalovirus Infection Is Associated With Impaired Left Ventricular Function After ST-Segment-Elevation
Luke Spray1, Alasdair McIntosh2, Peter J McCartney3
1Translational and Clinical Research Institute Newcastle University Newcastle Upon Tyne United Kingdom.
Insights
Latent cytomegalovirus infection is associated with poorer outcomes after ST-segment-elevation myocardial infarction (STEMI). Patients with STEMI and cytomegalovirus (CMV) positivity experienced impaired reperfusion and reduced heart function.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- Human cytomegalovirus (CMV) is a prevalent herpesvirus globally.
- CMV infection is linked to increased cardiovascular disease risk.
- The impact of CMV on ST-segment-elevation myocardial infarction (STEMI) outcomes remains unclear.
Purpose of the Study:
- To investigate the association between latent CMV infection and patient outcomes following STEMI.
- To determine if CMV positivity affects myocardial reperfusion, cardiac function, and quality of life post-STEMI.
Main Methods:
- 354 STEMI patients from the T-TIME trial with cryopreserved samples were analyzed.
- Cytomegalovirus (CMV) IgG antibody titers were measured in baseline samples.
- Outcomes assessed included ST-segment resolution, left ventricular ejection fraction, and quality of life via EuroQol 5-Dimension visual analog scale.
Main Results:
- CMV-positive patients (74.9%) were older and more likely to be non-White.
- Less successful myocardial reperfusion (ST-segment resolution) was observed in CMV-positive individuals (38.7% vs. 48.4%, P=0.032).
- CMV positivity was associated with lower left ventricular ejection fraction at 1 week (42.6% vs. 45.3%, P=0.006) and 3 months (47.8% vs. 49.7%, P=0.033), and poorer quality of life improvement (P<0.001).
Conclusions:
- Latent cytomegalovirus infection is associated with impaired myocardial reperfusion after STEMI.
- CMV positivity correlates with reduced left ventricular function and less improvement in quality of life in STEMI patients.
- These findings suggest CMV may negatively influence recovery and long-term outcomes following STEMI.
Background:
Human cytomegalovirus is a herpes virus that affects most individuals globally and may increase the risk of cardiovascular disease. Whether cytomegalovirus influences outcomes after ST-segment-elevation myocardial infarction (STEMI) is unknown. Our objective was to investigate the association between latent cytomegalovirus infection and outcomes after STEMI.
Methods:
This study includes 354 patients with STEMI who were recruited to T-TIME (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI) and had blood samples cryopreserved. Participants underwent immediate percutaneous coronary intervention, serial cardiovascular magnetic resonance imaging at 2 to 7 days and 3 months post-STEMI, and assessment of health-related quality of life with the EuroQol 5-Dimension visual analog scale. Cytomegalovirus Ig (immunoglobulin) G titer was measured in cryopreserved baseline samples from each patient. Results were adjusted for age and other possible confounders.
Results:
One hundred seventy-five patients (49.4%) were cytomegalovirus IgG titer-negative, 89 (25.1%) were low-positive, and 90 (25.4%) were high-positive. Patients who were cytomegalovirus-positive were older (62.5 versus 58.7 years of age) and more likely to be non-White (6.7% versus 2.3%). Myocardial reperfusion, measured by ST-segment resolution, was less successful in patients who were cytomegalovirus-positive (38.7% resolution versus 48.4%; adjusted P=0.032). Left ventricular ejection fraction was lower in patients who were cytomegalovirus-positive in the first week (42.6% versus 45.3%; adjusted P=0.006) and at 3 months (47.8% versus 49.7%; adjusted P=0.033). Over 3 months, patients who were cytomegalovirus-positive had less improvement in health-related quality of life (change in EuroQol 5-Dimension visual analog scale: +3.38 versus +9.93; adjusted P<0.001).
Conclusions:
Patients who are cytomegalovirus-positive with STEMI have impaired reperfusion, reduced left ventricular function, and less improvement in health-related quality of life over 3 months.
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