title: Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
abstract: Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all-cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.
  
  
  
  In this substudy of the DANAMI-3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2(women). One hundred seventy-eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10-21] vs 9% [IQR, 3-17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5-0.7] vs 0.7 [IQR, 0.5-0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47-60] vs 61% [IQR, 55-65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all-cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38-4.90], P=0.003). The results remained statistically significant in multivariable models.
  
  
  
  LVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all-cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark lars.nepper@gmail.com.
authors.forename: Lars
authors.initials: L
authors.lastname: Nepper-Christensen
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Kiril Aleksov
authors.initials: KA
authors.lastname: Ahtarovski
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Dan Eik
authors.initials: DE
authors.lastname: Høfsten
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Kyhl
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Adam Ali
authors.initials: AA
authors.lastname: Ghotbi
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.|Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Göransson
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Litten
authors.initials: L
authors.lastname: Bertelsen
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Saünamaki
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.affiliation: Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: ST‐segment elevation myocardial infarction; cardiac magnetic resonance imaging; left ventricular hypertrophy; myocardial infarction; primary percutaneous coronary intervention