Latent Cytomegalovirus Infection Is Associated With Impaired Left Ventricular Function After ST-Segment-Elevation Myocardial Infarction.

BACKGROUND

Human cytomegalovirus is a herpes virus that affects most individuals globally and may increase the risk of cardiovascular disease. Whether cytomegalovirus influences outcomes after ST-segment-elevation myocardial infarction (STEMI) is unknown. Our objective was to investigate the association between latent cytomegalovirus infection and outcomes after STEMI.

METHODS

This study includes 354 patients with STEMI who were recruited to T-TIME (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI) and had blood samples cryopreserved. Participants underwent immediate percutaneous coronary intervention, serial cardiovascular magnetic resonance imaging at 2 to 7 days and 3 months post-STEMI, and assessment of health-related quality of life with the EuroQol 5-Dimension visual analog scale. Cytomegalovirus Ig (immunoglobulin) G titer was measured in cryopreserved baseline samples from each patient. Results were adjusted for age and other possible confounders.

RESULTS

One hundred seventy-five patients (49.4%) were cytomegalovirus IgG titer-negative, 89 (25.1%) were low-positive, and 90 (25.4%) were high-positive. Patients who were cytomegalovirus-positive were older (62.5 versus 58.7 years of age) and more likely to be non-White (6.7% versus 2.3%). Myocardial reperfusion, measured by ST-segment resolution, was less successful in patients who were cytomegalovirus-positive (38.7% resolution versus 48.4%; adjusted P=0.032). Left ventricular ejection fraction was lower in patients who were cytomegalovirus-positive in the first week (42.6% versus 45.3%; adjusted P=0.006) and at 3 months (47.8% versus 49.7%; adjusted P=0.033). Over 3 months, patients who were cytomegalovirus-positive had less improvement in health-related quality of life (change in EuroQol 5-Dimension visual analog scale: +3.38 versus +9.93; adjusted P<0.001).

CONCLUSIONS

Patients who are cytomegalovirus-positive with STEMI have impaired reperfusion, reduced left ventricular function, and less improvement in health-related quality of life over 3 months.