Determinants and prognostic relevance of aortic stiffness in patients with recent ST-elevation myocardial infarction

Ivan Lechner, Martin Reindl, Christina Tiller, Magdalena Holzknecht, Sarah Niederreiter, Agnes Mayr, Gert Klug, Christoph Brenner, Axel Bauer, Bernhard Metzler, Sebastian Johannes Reinstadler, Ivan Lechner, Martin Reindl, Christina Tiller, Magdalena Holzknecht, Sarah Niederreiter, Agnes Mayr, Gert Klug, Christoph Brenner, Axel Bauer, Bernhard Metzler, Sebastian Johannes Reinstadler

Abstract

The association between aortic stiffness, cardiovascular risk factors and prognosis in patients with recent ST-elevation myocardial infarction (STEMI) is poorly understood. We analyzed the relationship between cardiovascular risk factors and arterial stiffening and assessed its prognostic significance in patients with recent STEMI. We prospectively enrolled 408 consecutive patients who sustained a first STEMI and underwent primary percutaneous coronary intervention (PPCI). Aortic pulse wave velocity (PWV), the most widely used measure of aortic stiffness, was determined by the transit-time method using velocity-encoded, phase-contrast cardiac magnetic resonance imaging. Patient characteristics were acquired at baseline and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 13 [interquartile range (IQR) 12-31] months. Cox regression- and logistic regression analysis were performed to explore predictors of aortic stiffness and MACCE. Median aortic PWV was 6.6 m/s (IQR 5.6-8.3 m/s). In multivariable analysis, age [odds ratio (OR) 1.10, 95% confidence interval (CI), 1.08-1.14, p < 0.001] and hypertension (OR 2.45, 95% CI, 1.53-3.91, p < 0.001) were independently associated with increased PWV. Sex, diabetes, smoking status, dyslipidemia, and obesity were not significantly associated with PWV in adjusted analysis (all p > 0.05). High PWV significantly and independently predicted occurrence of MACCE in adjusted analysis [hazard ratio (HR) 2.45, 95% CI 1.19-5.04, p = 0.014]. In patients with recent STEMI, the impact of classical cardiovascular risk factors on aortic stiffness is mainly dependent on age and increased blood pressure. Increased aortic stiffness is associated with adverse clinical outcome post-STEMI, suggesting it as a relevant therapeutic target in this population. Trial (NCT04113356).

Keywords: Aortic stiffness; Cardiac magnetic resonance; Cardiovascular risk factors; Prognosis; Pulse wave velocity; ST-segment elevation myocardial infarction.

Conflict of interest statement

The authors declare that there is no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CMR determined PWV assessment. CMR cardiac magnetic resonance, PWV pulse wave velocity, aA ascending aorta, dA descending aorta, abdA abdominal aorta, t time (Created with Biorender)
Fig. 2
Fig. 2
Association of aortic PWV in relation to age, hypertension and clinical outcome. PWV pulse wave velocity, STEMI ST-elevation myocardial infarction, CAD coronary artery disease, AS atherosclerosis, MACCE major adverse cardiac and cerebrovascular events (Created with Biorender)

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