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 =0.032). Left ventricular ejection fraction was lower in patients who were cytomegalovirus-positive in the first week (42.6% versus 45.3%; adjusted =0.006) and at 3 months (47.8% versus 49.7%; adjusted =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 <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.