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

Andreas Schuster; Sören J Backhaus; Thomas Stiermaier; Jenny-Lou Navarra; Johannes Uhlig; Karl-Philipp Rommel; Alexander Koschalka; Johannes T Kowallick; Boris Bigalke; Shelby Kutty; Matthias Gutberlet; Gerd Hasenfuß; Holger Thiele; Ingo Eitel

doi:10.3390/jcm9010210

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

J Clin Med. 2020 Jan 12;9(1):210. doi: 10.3390/jcm9010210.

Authors

Affiliations

¹ Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), Göttingen, 37075, Germany.
² Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW 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), Lübeck, 23538, Germany.
⁴ University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, German Center for Cardiovascular Research (DZHK), Göttingen, 37075, Germany.
⁵ Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig Heart Institute, Leipzig, 04289, Germany.
⁶ Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, 12203, Germany.
⁷ Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
⁸ Department of Radiology, Heart Center Leipzig, University of Leipzig, Leipzig, 04289, Germany.

Abstract

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 ε_s), conduit (passive strain ε_e), booster pump function (active strain ε_a), 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 (ε_s p = 0.061, SRs p = 0.049) and conduit functions (ε_e p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (ε_a 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.

Keywords: cardiac magnetic resonance; feature tracking; myocardial infarction; prognosis; right atrium; risk stratification; strain; strain rate.

Grants and funding

N/A/Deutsches Zentrum für Herz-Kreislaufforschung