Ewha Med J.  2013 Mar;36(1):26-34. 10.12771/emj.2013.36.1.26.

The Differences of Left Ventricular Geometry in Acute Myocardial Infarction and the Effects on Short Term Mortality

• Kim KJ
• Kang IS
• Kwon K
• Pyun WB
• Shin GJ

• KMID: 2284012
• DOI: http://doi.org/10.12771/emj.2013.36.1.26

Abstract

OBJECTIVES
This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry.
METHODS
Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes.
RESULTS
Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7).
CONCLUSION
NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.

Keyword

Acute myocardial infarction; NSTEMI; Remodeling; STEMI; Survival

MeSH Terms

Diabetes Mellitus
Female
Heart Failure
Humans
Hypertension
Hypertrophy
Myocardial Infarction
Proportional Hazards Models
Stroke

Figure

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  Fig. 1 Unadjusted hazard ratios (95% confidence intervals) for all cause mortality. Cox proportional hazards models are used. CI, confidence interval; DM, diabetes mellitus; HTN, hypertension; HF, heart failure; CR, concentric remodeling; EH, ecoentric hypertrophy; CH, concentric hypertrophy; Ref, referent value.

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  Fig. 2 Adjusted hazard ratios (95% confidence intervals) for all cause mortality. Multivariable Cox proportional hazards models are used. CI, confidence interval; DM, diabetes mellitus; HTN, hypertencsion; HF, heart failure; CR, concentric remodeling; EH, ecoentric hypertrophy; CH, concentric hypertrophy; Ref, referent value.

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  Fig. 3 Unadjusted hazard ratios (95% confidence intervals) for cardiovascular mortality. Cox proportional hazards models are used. CI, confidence interval; DM, diabetes mellitus; HTN, hypertension; HF, heart failure; CR, concentric remodeling; EH, ecoentric hypertrophy; CH, concentric hypertrophy; Ref, referent value.

• 

  Fig. 4 Adjusted hazard ratios (95% confidence intervals) for cardiovascular mortality. Multivariable Cox proportional hazards models are used. CI, confidence interval; DM, diabetes mellitus; HTN, hypertencsion; HF, heart failure; CR, concentric remodeling; EH, ecoentric hypertrophy; CH, concentric hypertrophy; Ref, referent value.

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