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Left ventricular hypertrophy (LVH) is a well-known predictor of heart failure in the general population. However, its clinical significance in the setting of acute coronary syndrome has not been well established. We aimed to determine the predictive value of echocardiographic LVH for in-hospital heart failure in patients with non-ST elevation myocardial infarction (NSTEMI).
We performed a retrospective analysis of 481 consecutive NSTEMI patients who underwent coronary angiography within five days after presentation. Transthoracic echocardiography was performed in a standard fashion during hospitalization and 309 patients had sufficient data to calculate left ventricular mass index. Obstructive coronary artery disease was defined as stenosis greater than or equal to 70% (50% in the left main coronary artery). LVH was defined as left ventricular mass index >95 g/m2 (female) and > 115 g/m2 (male). Baseline and angiographic characteristics, in-hospital revascularization procedures and heart failure as well as in-hospital and 30-day major adverse cardiac event (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were compared between the two groups.
Among 309 patients, 91 patients (29.4%) had echocardiographic LVH, 241 patients (78.0%) had obstructive coronary artery disease and 182 patients (58.9%) underwent in-hospital revascularization. The LVH group had a higher rate of chronic kidney disease (48.4% vs. 27.1%, p=0.001). Patients with echocardiographic LVH had a higher incidence of in-hospital heart failure (33.0% vs. 11.9%, p<0.001). The association between LVH and in-hospital heart failure remained significant in the subgroups of patients who had obstructive coronary artery disease (31.9% vs. 14.8%, p=0.002) and those who underwent in-hospital revascularization (31.1% vs. 14.6%, p=0.01). The association between echocardiographic LVH and in-hospital heart failure persisted after adjusting for age, hypertension, chronic kidney disease and left ventricular ejection fraction less than 50% (odds ratio 2.35; 95% confidence interval, 1.21-4.56; p=0.01). At 30-day follow-up, there was a trend toward a higher incidence of MACE in patients with LVH (6.6% vs. 2.8%, p=0.11).
Our study demonstrated that echocardiographic LVH was observed in a quarter of NSTEMI patients and an independent predictor for in-hospital heart failure.