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Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance
Open AccessArticle

Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction

1
Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany
2
Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney 2065, Australia
3
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, German Center for Cardiovascular Research (DZHK), 23538 Lübeck, Germany
4
University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany
5
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig Heart Institute, 04289 Leipzig, Germany
6
Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, 12203 Berlin, Germany
7
Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD 21287, USA
8
Department of Radiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany
*
Author to whom correspondence should be addressed.
Equal contribution as first and senior authors.
J. Clin. Med. 2020, 9(1), 210; https://doi.org/10.3390/jcm9010210 (registering DOI)
Received: 9 December 2019 / Revised: 3 January 2020 / Accepted: 6 January 2020 / Published: 12 January 2020
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. The primary endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT-derived quantification of RA strain. View Full-Text
Keywords: myocardial infarction; risk stratification; prognosis; cardiac magnetic resonance; strain; strain rate; feature tracking; right atrium myocardial infarction; risk stratification; prognosis; cardiac magnetic resonance; strain; strain rate; feature tracking; right atrium
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Schuster, A.; Backhaus, S.J.; Stiermaier, T.; Navarra, J.-L.; Uhlig, J.; Rommel, K.-P.; Koschalka, A.; Kowallick, J.T.; Bigalke, B.; Kutty, S.; Gutberlet, M.; Hasenfuß, G.; Thiele, H.; Eitel, I. Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction. J. Clin. Med. 2020, 9, 210.

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