Abstract

Objective: This study aims to explore the relationship between clonal haematopoiesis of indeterminate potential and poor adverse left ventricle remodeling in ST-elevation myocardial infarction. Methods: This was a prospective cohort of 340 patients with ST-Elevation Myocardial Infarction (STEMI) who presented for primary Percutaneous Coronary Intervention (PCI) and were screened for clonal haematopoiesis (VAF >2%) with targeted Next-Generation Sequencing (NGS) having a Cardiac Magnetic Resonance imaging (CMR) examination at baseline and at 6 months. An increase in E.D.V.I. >20% was thought to represent adverse remodeling. Cox regression was used in a multivariable logistic regression framework to test the definition of inflammatory markers of the association with clonal haematopoeseesis and major cardiovascular events. Results: Clonal haematopoiesis was detected (typically for DNMT3A) in 69 patients. Carriers were found to have greater concentration of interleukin-6, microvascular obstruction and infarcts than non-carriers (all p<0.001). 70% of carriers and 25% of non-carriers had adverse remodeling, which was independently associated with clonal haematopoiesis after adjustment for infarct size, microvascular obstruction, anterior infarction as well as age and diabetes. Association was observed over the most common genes. During follow-up, there was a greater frequency of Major Adverse Cardiovascular Events (MACE) in carriers (p<0.001). Conclusion: Independently of regular monitoring of CHIP was associated with adverse LV remodelling and prognosis after STEMI, as expected. Screening could prove patients with clonal haematopoiesis are sensitive to targeted anti-inflammatory therapy and that they may be at risk of developing heart failure in the wake of an infarction.

Keywords: Clonal haematopoiesis, CHIP, ST-elevation myocardial infarction, Heart failure, Inflammation, Cardiac magnetic resonance