1
|
Yehia A, Zaki A, Sadaka M, Azeem AMAE. Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI). Echocardiography 2024; 41:e15725. [PMID: 38078679 DOI: 10.1111/echo.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. METHODS One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6 weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. RESULTS The mean change of EF was 8.04 ± 3.32% in group I versus -.39 ± 5.09 % in group II (p < .001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6 weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p < .001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. CONCLUSIONS Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.
Collapse
Affiliation(s)
- Ahmed Yehia
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Zaki
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sadaka
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | |
Collapse
|
2
|
Kurt D, Yılmaz E, Çamcı S, Aydın E, Çelik Ş. Incidence and Predictors of Left Ventricular Thrombus Formation After Acute Myocardial Infarction With ST-Segment Elevation. Cureus 2023; 15:e50495. [PMID: 38222227 PMCID: PMC10787315 DOI: 10.7759/cureus.50495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Background and objective Our prospective study aimed to evaluate the frequency and risk factors of left ventricular thrombus (LVT) occurring after acute ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PCI). Methods Our study included 131 patients diagnosed with acute STEMI who were followed up and treated. The presence of the thrombus was determined by transthoracic echocardiography (TTE). Study patients were evaluated as cases of thrombus (+) and thrombus (-). The relationship of electrocardiographic measurements such as the number of leads with pathological Q waves, ST segment deviation score, QT dispersion, and echocardiographic measurements such as ejection fraction (EF), end-systolic and end-diastolic volumes, and wall motion score index (WMSI) with LVT was investigated. LVT risk factors were identified. Results The median age of the study patients was 59.7 ± 11.7 years, and 84.7% were male. The incidence of LVT was 17.6% (23 patients). While the anterior STEMI rate was 86.9% in the thrombus (+) group, it was 50.9% in the thrombus (-) group (p<0.001). While WMSI was 2.1 ± 0.44 in the thrombus (+) group, it was calculated as 1.40 ± 0.31 in the thrombus (-) group (p<0.001). In the thrombus (+) group, EF was found to be lower, end-systolic and end-diastolic volumes were higher, and the rate of moderate and severe mitral regurgitation and the rate of aneurysmatic segment detection were higher. LVT had a moderate correlation with WMSI (r: 0.613; p<0.001), the presence of an aneurysmatic segment (r: 0.549; p<0.001), and EF (r: -0.514; p<0.001). Presentation with anterior STEMI (odds ratio [OR]: 4.266; p<0.001), WMSI (OR: 7.971; p=0.012), the number of leads with pathological Q waves detected at discharge (OR: 3.651; p=0.009), the presence of an aneurysmatic segment (OR: 2.089, p=0.009), and EF (OR: 1.129, p=0.006) were identified as independent risk factors of the presence of LVT. The area under the curve for WMSI was found to be 0.910 (95% CI: 0.852-0.968). A WMSI cut-off of 1.56 identified LVT with 91% sensitivity and 70% specificity (Youden index: 0.617). Conclusion In the primary PCI era, LVT incidence after acute STEMI is still significant. Anterior STEMI, the number of leads with pathological Q waves detected at discharge, WMSI, aneurysm formation, and low EF are independent risk factors for LVT. Among these risk factors, the variable with the highest diagnostic power is WMSI.
Collapse
Affiliation(s)
- Devrim Kurt
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Emre Yılmaz
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Sencer Çamcı
- Cardiology, Bursa Postgraduate Hospital, Bursa, TUR
| | - Ertan Aydın
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Şükrü Çelik
- Cardiology, Trabzon Ahi Evran Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, TUR
| |
Collapse
|
3
|
Zhu JY, Wang XC, Huang N, Li XQ, Cheng Y, Wu ZF, Li YY, Wu P, Li L, Wei H, Li SJ, Cao JM. Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy. Front Cardiovasc Med 2023; 10:1144333. [PMID: 37008320 PMCID: PMC10050370 DOI: 10.3389/fcvm.2023.1144333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundThe prognosis of patients with dilated cardiomyopathy (DCM) is poor and new indicators are urgently needed to predict lethal cardiac events. This study aimed to investigate the value of summed motion score (SMS) in predicting cardiac death of DCM patients using gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).Methods and resultsEighty-one patients with DCM who underwent 99mTc-MIBI gated SPECT MPI were retrospectively enrolled and were divided into cardiac death and survivor groups. The functional parameters of left ventricle including SMS were measured using quantitative gated SPECT software. During the follow-up period of 44 (25, 54) months, 14 (17.28%) cardiac deaths were observed. Compared with the survivor group, SMS was significantly higher in the cardiac death group. Multivariate cox regression analysis showed that SMS was an independent predictor for cardiac death (HR 1.34, 95% CI 1.02–1.77, P = 0.034). SMS also provided incremental prognostic value over other variables in the multivariate model as determined by likelihood ratio global chi-squared test. In the Kaplan-Meier survival analysis, the event-free survival rate was significantly lower in the high-SMS (HSMS) group than the low-SMS (LSMS) (log-rank P < 0.001). Furthermore, the area under curve (AUC) of SMS was larger than that of LVEF at the 12th month of follow-up (0.85 vs. 0.80, P = 0.045).ConclusionSMS is an independent predictor of cardiac death in DCM patients and provides incremental prognostic value. SMS might have higher predictive value than LVEF for early cardiac death.
Collapse
Affiliation(s)
- Jun-Yan Zhu
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
- Department of Physiology, Shanxi Medical University, Taiyuan, China
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin-Chao Wang
- School of Public Health, Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China
| | - Nan Huang
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Qian Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Cheng
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China
| | - Zhi-Fang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China
| | - Yuan-Yuan Li
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
- Department of Physiology, Shanxi Medical University, Taiyuan, China
- Department of Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ping Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China
| | - Li Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China
| | - Hua Wei
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Si-Jin Li
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Correspondence: Si-Jin Li ; Ji-Min Cao
| | - Ji-Min Cao
- Key Laboratory of Cellular Physiology at Shanxi Medical University, Ministry of Education, Taiyuan, China
- Department of Physiology, Shanxi Medical University, Taiyuan, China
- Correspondence: Si-Jin Li ; Ji-Min Cao
| |
Collapse
|
4
|
|
5
|
Khoshnood A, Akbarzadeh M, Roijer A, Meurling C, Carlsson M, Bhiladvala P, Höglund P, Sparv D, Todorova L, Mokhtari A, Erlinge D, Ekelund U. Effects of oxygen therapy on wall-motion score index in patients with ST elevation myocardial infarction-the randomized SOCCER trial. Echocardiography 2017; 34:1130-1137. [DOI: 10.1111/echo.13599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ardavan Khoshnood
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - Mahin Akbarzadeh
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - Anders Roijer
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Carl Meurling
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - Peter Höglund
- Region Skåne Research and Development Center; Lund Sweden
| | - David Sparv
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - Arash Mokhtari
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund; Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences Lund; Emergency and Internal Medicine; Skåne University Hospital; Lund University; Lund Sweden
| |
Collapse
|
6
|
Jurado-Román A, Agudo-Quílez P, Rubio-Alonso B, Molina J, Díaz B, García-Tejada J, Martín R, Tello R. Superiority of wall motion score index over left ventricle ejection fraction in predicting cardiovascular events after an acute myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 8:78-85. [DOI: 10.1177/2048872616674464] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There are few data on the prognostic significance of the wall motion score index compared with left ventricle ejection fraction after an acute myocardial infarction. Our objective was to compare them after the hyperacute phase. Methods: Transthoracic echocardiograms were performed in 352 consecutive patients with myocardial infarction, after the first 48 hours of admission and before hospital discharge (median 56.3 hours (48.2–83.1)). We evaluated the ability of the wall motion score index and left ventricular ejection fraction to predict the combined endpoint (mortality and rehospitalization for heart failure) as a primary objective and the independent events of the combined endpoint as a secondary objective. Results: In 80.7% of patients, the wall motion score index was high despite having an ejection fraction >40%. No patient had an ejection fraction <55% with a normal index. After a follow-up of 30.5 months (24.2–49.5), both variables were predictors of the composite endpoint and all-cause mortality ( p<0.0001), although only the wall motion score index was a predictor of readmission for heart failure ( p=0.007). By multivariate analysis, a wall motion score index >1.8 proved to be the most powerful predictor of the composite endpoint (hazard ratio: 8.5; 95% confidence interval 3.7–18.8; p<0.0001). The superiority of the wall motion score index over ejection fraction was especially significant in patients with less myocardial damage (non-ST elevation myocardial infarction, or left ventricle ejection fraction >40%). Conclusions: Both variables provide important prognostic information after a myocardial infarction. Beyond the hyperacute phase, wall motion score index is a more powerful prognostic predictor, especially in subgroups with less myocardial damage.
Collapse
Affiliation(s)
| | | | | | | | - Belén Díaz
- University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Rocío Tello
- University Hospital 12 de Octubre, Madrid, Spain
| |
Collapse
|
7
|
Johnson J, Manouras A, Bergholm F, Brodin LÅ, Agewall S, Henareh L. The early diastolic myocardial velocity: a marker of increased risk in patients with coronary heart disease. Clin Physiol Funct Imaging 2014; 34:389-96. [PMID: 24438358 DOI: 10.1111/cpf.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Tissue Doppler imaging (TDI) is a promising echocardiographic modality allowing quantification of myocardial performance. However, the prognostic potential of TDI in patients with acute myocardial infarction (AMI) is not yet investigated. We sought to explore the ability of TDI in identifying patients at risk for new cardiovascular events after AMI. METHODS One hundred and nineteen patients with AMI were recruited prospectively (mean age 61 years; range 32-81 years of age). Patients with diabetes mellitus (DM) were excluded. Echocardiography was performed 3-12 months after AMI. Two-dimensional (2-D) and TDI variables were recorded. The patients were followed during a mean period of 4·6 years (range 1-8 years). The primary end-point was defined as any of the following: death from any cause, non-fatal reinfarction or stroke, unstable angina pectoris, congestive heart failure requiring hospitalization and coronary revascularization procedure. RESULTS Thirty patients had some form of cardiovascular events during follow-up. Seven patients had cardiovascular death, 13 patients had reinfarction and four patients had a stroke. New angina or unstable angina was recorded in 21 patients. Of these patients, 13 underwent percutaneous coronary angioplasty (PCI) or coronary artery bypass grafting (CABG). The early diastolic myocardial velocity (E(m)) emerged as the only echocardiographic variable that offered a clear differentiation between patients that presented with new cardiovascular (CV) events as compared to the corresponding group without any CV events at follow-up (P<0·05). In multivariate statistical analysis and after adjustment for age, sex, total cholesterol, body mass index (BMI) and other baseline characteristics, Em remained as independent predictors of CV events (HR, 1·18, 95% CI, 1·02-1·36; P<0·05). However, none of the investigated variables evolved as an independent predictor of cardiovascular morbidity and mortality. CONCLUSION E(m) appears to be a sensitive echocardiographic index in identifying non-diabetic patients with AMI at risk of new cardiovascular events.
Collapse
Affiliation(s)
- Jonas Johnson
- School for Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
8
|
Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Bigio E, Marchetti L, Biagioli B. Prediction of stroke volume by global left ventricular longitudinal strain in patients undergoing assessment for cardiac transplantation. J Crit Care 2011; 26:433.e13-20. [DOI: 10.1016/j.jcrc.2010.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/16/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
|
9
|
Verma A, Pfeffer MA, Skali H, Rouleau J, Maggioni A, McMurray JJV, Califf RM, Velazquez EJ, Solomon SD. Incremental value of echocardiographic assessment beyond clinical evaluation for prediction of death and development of heart failure after high-risk myocardial infarction. Am Heart J 2011; 161:1156-62. [PMID: 21641363 DOI: 10.1016/j.ahj.2011.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 03/18/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographic measurements of left ventricular (LV) function, predominantly LV ejection fraction (LVEF), have been used to define risk in patients after myocardial infarction. However, the extent to which measures of LV structure and function provide incremental prognostic value over clinical variables in survivors of high-risk myocardial infarction has not been well defined. METHODS Predictors of death and development of heart failure were assessed in 603 patients from the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiographic substudy. We used multivariable proportional hazards models to assess the individual predictive value of echocardiographic measures including left ventricular mass index, LVEF, LV volumes, left atrial volume index, right ventricular fractional area change, mitral regurgitation, and deceleration time. We adjusted for the 11 clinical variables found previously to be most associated with all-cause mortality in this cohort. Receiver operating characteristic curves obtained via binary response regression were used to assess the incremental predictive value of echocardiographic measures in predicting outcomes of death and hospital stay for heart failure. RESULTS Each echocardiographic measure was independently associated with outcome of death or development of heart failure (all P < .002). Left ventricular ejection fraction alone added minimal prognostic value to the clinical assessment, yet adding additional echocardiographic assessments to a multivariable model improved in predicting 17-month survival free of heart failure significantly, increasing the c-statistic from 0.74 to 0.84 (P < .001). CONCLUSION Echocardiographic measures of cardiac structure and function beyond LVEF provide important prognostic information beyond the clinical assessment.
Collapse
Affiliation(s)
- Anil Verma
- Cardiovascular Division, Ochsner Medical Center, New Orleans, LA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Jang JY, Woo JS, Kim WS, Ha SJ, Sohn IS, Kim W, Bae JH, Kim KS. Serial assessment of left ventricular remodeling by measurement of left ventricular torsion using speckle tracking echocardiography in patients with acute myocardial infarction. Am J Cardiol 2010; 106:917-23. [PMID: 20854950 DOI: 10.1016/j.amjcard.2010.05.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 05/16/2010] [Accepted: 05/16/2010] [Indexed: 11/16/2022]
Abstract
The relation between remodeling and left ventricular (LV) torsion has not yet been fully investigated. The aim of this study was to determine whether LV torsion assessed by speckle tracking imaging can predict progressive LV dilation after acute myocardial infarction (AMI). From January 2006 through June 2008, 91 patients with AMI who were successfully treated with primary coronary intervention underwent conventional and speckle tracking echocardiographies at initial presentation and 3 days and 6 months after first AMI. Patients were divided into 2 groups based on presence of LV remodeling (increase of LV end-diastolic volume >20%) at 6-month follow-up. LV remodeling developed in 23 patients. At initial presentation, LV end-diastolic volume was not significantly different between the no-remodeling and remodeling groups (91.27 ± 35.68 vs 85.74 ± 28.89 ml, p = 0.51), but LV torsion (2.23 ± 0.67 vs 1.70 ± 0.58°/cm, p <0.05) was significantly decreased in the remodeling group. At 6-month follow-up speckle tracking echocardiography, apical rotation and global torsion in patients with remodeling were 6.7 ± 2.6 (p <0.05) and 1.7 ± 0.7°/cm (p = 0.76 from baseline), respectively, and in patients without remodeling, 8.8 ± 3.4 (p <0.01) and 2.5 ± 0.7°/cm (p <0.01 from baseline), respectively. According to receiver operating characteristic analysis, LV torsion of 1.9°/cm (area under curve 0.79, sensitivity 75%, specificity 78%) at initial presentation was selected as a significant predictor of remodeling. In conclusion, decreased LV torsion assessed by speckle tracking echocardiography may predict late LV remodeling after reperfusion therapy after AMI.
Collapse
Affiliation(s)
- Jeong Yoon Jang
- Division of Cardiology, Department of Internal Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Jedrzkiewicz S, Goodman SG, Yan RT, Grondin FR, Gallo R, Welsh RC, Lai K, Huynh T, Yan AT. Evaluation of left ventricular ejection fraction in non-ST-segment elevation acute coronary syndromes and its relationship to treatment. Am Heart J 2010; 159:605-11. [PMID: 20362719 DOI: 10.1016/j.ahj.2010.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 01/29/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND In-hospital assessment of left ventricular ejection fraction (LVEF) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is emphasized in current practice guidelines. There are limited data regarding the evaluation of LVEF and clinical characteristics and in-hospital management in the "real world." METHODS Registries including the Canadian Acute Coronary Syndrome (ACS) I and II, Global Registry of Acute Coronary Events (main GRACE/expanded GRACE(2)), and Canadian Registry of Acute Coronary Events (CANRACE) enrolled 13,703 NSTE-ACS patients across Canada between 1999 and 2008. Patients were stratified by in-hospital LVEF measurement, and LVEF was categorized as normal, mildly, or moderately to severely impaired. We compared clinical characteristics, cardiac procedures, and clinical outcomes across these groups. Multivariable logistic regression identified factors independently associated with the assessment of LVEF. RESULTS Overall, 8,116 patients (59.2%) had LVEF measurement, and of the 7,667 patients with available LVEF data, 4,470 (58.3%) had normal, 1,916 (25%) mildly impaired, and 1,281 (16.7%) moderately to severely impaired LVEF. Patients with LVEF assessment more frequently (all P < .001) underwent cardiac catheterization, percutaneous coronary intervention or coronary bypass surgery, and had higher (both P < .001) rates of myocardial (re) infarction and heart failure. In-hospital reinfarction, higher Killip class, abnormal biomarker, hospital stay >10 days, and on-site cardiac catheterization facility were independently associated with LVEF assessment. Despite increasing LVEF assessment over time (P for trend < .001), 31.2% of patients in the most recent registry (2008) had no in-hospital LVEF assessment. CONCLUSIONS In-hospital LVEF assessment is not performed in many NSTE-ACS patients. The LVEF assessment, associated with increased use of evidence-based therapies and invasive cardiac procedures, was obtained more frequently in patients with myocardial (re) infarction, heart failure on presentation, and prolonged hospital stay.
Collapse
Affiliation(s)
- Sean Jedrzkiewicz
- Terrence Donnelly Heart Center, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Larose E, Côté J, Rodés-Cabau J, Noël B, Barbeau G, Bordeleau E, Miró S, Brochu B, Delarochellière R, Bertrand OF. Contrast-enhanced cardiovascular magnetic resonance in the hyperacute phase of ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2009; 25:519-27. [DOI: 10.1007/s10554-009-9451-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 03/03/2009] [Indexed: 10/21/2022]
|
13
|
Jeetley P, Senior R. Clinical Echocardiography. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
14
|
Arruda-Olson AM, Pellikka PA, Bursi F, Jaffe AS, Santrach PJ, Kors JA, Killian JM, Weston SA, Roger VL. Left ventricular function and heart failure in myocardial infarction: impact of the new definition in the community. Am Heart J 2008; 156:810-5. [PMID: 19061692 DOI: 10.1016/j.ahj.2008.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate ventricular function and the occurrence of heart failure (HF) among persons with myocardial infarction (MI) meeting only troponin criteria compared to persons meeting creatine kinase and its MB fraction (CK-MB) criteria. BACKGROUND The 2000 American College of Cardiology/European Society of Cardiology MI definition enabled identification of MIs meeting only troponin-based criteria. Data on ventricular function and HF among these are lacking. METHODS Between November 2002 and May 2006, we prospectively identified 835 persons with MI in the community using standardized criteria including cardiac pain, electrocardiogram, and biomarkers. Troponin and CK-MB were prospectively measured in all; each patient was classified according to the criteria met. RESULTS We performed echocardiograms (median of 1 day post-MI) in 482 patients (age 68+/-15 years; 45% women); 363 patients met CK-MB criteria, whereas 119 met only troponin criteria. The latter had lower wall motion score index (1.3+/-0.4 vs 1.5+/-0.5 for CK-MB; P<.01). Diastolic dysfunction was similar in both groups. After 1 year of follow up, 142 patients developed post-MI HF. Patients meeting only troponin criteria had a lower risk of HF after adjustment for age, sex, comorbidity (hazard ratio 0.56, 95% confidence interval 0.37-0.85, P<.01), which persisted after further adjustments for systolic or diastolic function. CONCLUSIONS In the community, the prospective application of the new MI definition identifies patients meeting only troponin criteria with better systolic function than cases meeting CK-MB criteria. Such MIs have a lower risk of subsequent HF. These findings are important for risk stratification in clinical practice.
Collapse
|
15
|
Relation Between Global Left Ventricular Longitudinal Strain Assessed with Novel Automated Function Imaging and Biplane Left Ventricular Ejection Fraction in Patients with Coronary Artery Disease. J Am Soc Echocardiogr 2008; 21:1244-50. [PMID: 18992675 DOI: 10.1016/j.echo.2008.08.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Indexed: 11/22/2022]
|
16
|
Lim SC, Rhee JA, Jeong MH, Choi JS, Shin ES, Kim KH, Kim JH, Moon JY, Hong YJ, Ahn YK, Cho JG, Park JC, Kang JC. Predictive Factors for the Recovery of Left Ventricular Dysfunction in Patients with Acute Myocardial Infarction. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.3.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sang Chun Lim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung Ae Rhee
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jin Soo Choi
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Eun Suk Shin
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jae Youn Moon
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jeong Gwang Cho
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| |
Collapse
|
17
|
Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J 2006; 151:419-25. [PMID: 16442909 DOI: 10.1016/j.ahj.2005.03.042] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 03/27/2005] [Indexed: 01/13/2023]
Abstract
BACKGROUND The prognostic importance of regional systolic function, as assessed by wall motion score index (WMSI), compared with global function, as assessed by left ventricular ejection fraction (LVEF), has not been assessed in large populations after acute myocardial infarction. METHODS Echocardiograms, including the assessment of WMSI and LVEF, were performed in 767 patients with acute myocardial infarction at a median of 1 day (25th and 75th percentiles 0-2 days) after admission. Patients were followed for a median of 19 months (range 12-28 months). Cox proportional hazards models were constructed for the primary study end point (all-cause mortality) and for a secondary end point (hospitalization for congestive heart failure). RESULTS During follow-up (median 40 months; range 32-50 months), 216 patients died and 54 patients were hospitalized for congestive heart failure. By univariate analysis, both LVEF (P < .0001) and WMSI (P < .0001) were powerful predictors of all-cause mortality. By a forward conditional Cox model, WMSI proved to be an independent predictor of death (hazard ratio 1.15 per 0.2-unit increase, 95% CI 1.10-1.21, P < .0001). When WMSI was included in the model, LVEF did not provide additional prognostic information (P = .77). Wall motion score index also proved to be an independent predictor of hospitalization for congestive heart failure (hazard ratio 1.21 per 0.2-unit increase, 95% CI 1.07-1.37, P = .002), whereas LVEF did not (P = .56). CONCLUSION Both LVEF and WMSI provide powerful prognostic information after acute myocardial infarction; however, the predictive power of WMSI is greater.
Collapse
Affiliation(s)
- Jacob E Møller
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | |
Collapse
|
18
|
Hedberg P, Jonason T, Lönnberg I, Nilsson G, Pehrsson K, Ringqvist I. Mitral Annulus Motion as a Predictor of Mortality in a Community-based Sample of 75-year-old Men and Women. J Am Soc Echocardiogr 2006; 19:88-94. [PMID: 16423675 DOI: 10.1016/j.echo.2005.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Indexed: 10/25/2022]
Abstract
Mitral annulus motion (MAM) is a predictor of mortality in selected patient groups, but its prognostic value in less selected populations is not known. In a community-based random sample of 75-year-old men and women (n = 408), left ventricular function was measured as: (1) maximum amplitude of MAM; and (2) wall-motion index. During a median follow-up of 7.2 years, 83 persons died (26 from cardiac causes). Left ventricular function as measured by MAM predicted the risk of all-cause and cardiac mortality independently of other potential risk factors in this community-based sample. Regarding cardiac mortality, the predictive ability of MAM was also independent of left ventricular systolic function measured as wall-motion index. MAM may prove to be a valuable complement to other echocardiographic methods in the assessment of prognosis in less selected populations.
Collapse
Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology, Central Hospital, Västerås, Sweden.
| | | | | | | | | | | |
Collapse
|
19
|
Hedberg P, Jonason T, Henriksen E, Lönnberg I, Nilsson G, Pehrsson K, Ringqvist I. Mitral annulus motion compared with wall motion scoring index in the assessment of left ventricular ejection fraction. J Am Soc Echocardiogr 2003; 16:622-9. [PMID: 12778022 DOI: 10.1016/s0894-7317(03)00115-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The biplane disc summation method is the recommended echocardiographic procedure to determine left ventricular (LV) ejection fraction (EF). Assessment of mitral annulus motion (MAM) or wall motion scoring index (WMI) has been reported to be less dependent on image quality compared with the recommended method, and proposed as a surrogate to the disc summation method in calculation of LVEF. We aimed to compare MAM and WMI in the echocardiographic assessment of LVEF. In a randomly selected population-based sample of 75-year-old men and women in sinus rhythm (n = 409) MAM, as measured by M-mode, was compared with WMI, calculated as the mean value of wall motion scoring in 9 LV segments. LVEF, as measured by the biplane disc summation method was used as reference. The limits of agreement (mean difference +/- 1.96 SD) between LVEF and corresponding MAM values were -18 to +13 LVEF%, and between LVEF and corresponding WMI values were -12 to +13 LVEF%. The areas under the receiver operating characteristic curves for MAM and WMI to predict a LVEF < 50% were 0.892 and 0.998, respectively (95% confidence interval of the difference 0.062-0.149). The corresponding areas for MAM and WMI to predict a LVEF < 40% were 0.955 and 0.998, respectively (95% confidence interval of the difference 0.017-0.069). In conclusion, the ability of WMI to estimate LVEF was more favorable than MAM in this population-based sample of 75-year-old participants. The findings suggest that the WMI is preferable to MAM in estimating LVEF.
Collapse
Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology, Division of Cardiology, University of Uppsala, Central Hospital, Västerås, Sweden.
| | | | | | | | | | | | | |
Collapse
|
20
|
Kjøller E, Køber L, Jørgensen S, Torp-Pedersen C. Short and long term prognostic importance of regional dyskinesia versus akinesia in acute myocardial infarction. Heart 2002; 87:410-4. [PMID: 11997405 PMCID: PMC1767089 DOI: 10.1136/heart.87.5.410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The prognostic importance of dyskinesia after acute myocardial infarction is unknown, and recommendations have been made that dyskinesia be included in calculations of wall motion index (WMI). OBJECTIVE To determine whether it is necessary to distinguish between dyskinesia and akinesia when WMI is estimated for prognostic purposes following acute myocardial infarction. DESIGN Multicentre prospective study. PATIENTS 6676 consecutive patients, screened one to six days after acute myocardial infarction in 27 Danish hospitals. INTERVENTIONS WMI was measured in 6232 patients, applying the nine segment model, scoring 3 for hyperkinesia, 2 for normokinesia, 1 for hypokinesia, 0 for akinesia, and -1 for dyskinesia. Calculation of WMI either included information on dyskinesia or excluded this information by giving dyskinesia the same score as akinesia. MAIN OUTCOME MEASURES Long term outcome (up to seven years) with respect to mortality. RESULTS Dyskinesia occurred in 673 patients (10.8%). In multivariate analysis, WMI was an important prognostic factor, with a relative risk of 2.4 (95% confidence interval (CI), 2.2 to 2.7), while dyskinesia had no independent long term prognostic importance (relative risk 1.00; 95% CI, 0.89 to 1.12). For 30 day mortality dyskinesia had a relative risk of 1.23 (95% CI, 1.00 to 1.53) (p = 0.045). CONCLUSIONS Echocardiographic evaluation of left ventricular systolic function shortly after an acute myocardial infarct gives important prognostic information, but the presence of dyskinesia only has prognostic importance for the first 30 days.
Collapse
Affiliation(s)
- E Kjøller
- Section of Cardiology E 105, Medical Department E, Herlev University Hospital, Herlev, Denmark.
| | | | | | | |
Collapse
|
21
|
McGowan JH, Martin W, Burgess MI, McCurrach G, Ray SG, McDonagh TA, Cleland JG. Validation of an echocardiographic wall motion index in heart failure due to ischaemic heart disease. Eur J Heart Fail 2001; 3:731-7. [PMID: 11738226 DOI: 10.1016/s1388-9842(01)00199-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS The echocardiographic assessment of left ventricular ejection fraction (LVEF) by geometric methods is limited in many patients because of inadequate views and also in the presence of regional wall motion abnormalities due to ischaemic heart disease (IHD). This study aimed to examine the application of a wall motion index (WMI) method, using a nine-segment LV model in patients with chronic heart failure (CHF) due to IHD. METHODS AND RESULTS Echocardiography was performed in 71 consecutive subjects with CHF due to IHD. WMI could be derived in 70 subjects (99%). The inter-observer variability (repeatability coefficient) of WMI was 0.66, i.e. LVEF+/-20%. In 66 subjects, LVEF was measured, within 4 weeks, using radionuclide ventriculography (RNV-EF). The inter-observer variability of RNV-EF was +/-3.1%. Using the mean of two observations for each method, the Bland-Altman range of agreement for LVEF was 26% (+/-13%). CONCLUSION WMI is a widely applicable echocardiographic method for assessing LV systolic function and has moderate agreement with RNV-EF. Unlike RNV-EF, however, WMI is not likely to be a suitable method for the measurement of small, but prognostically important, changes in LV function that may occur in CHF.
Collapse
Affiliation(s)
- J H McGowan
- Department of Medical and Nuclear Cardiology, Glasgow Royal Infirmary, G31 2ER, Glasgow, UK.
| | | | | | | | | | | | | |
Collapse
|
22
|
Galasko GI, Basu S, Lahiri A, Senior R. A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction. Heart 2001; 86:271-6. [PMID: 11514477 PMCID: PMC1729882 DOI: 10.1136/heart.86.3.271] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To characterise echocardiographic wall motion score index (WMSI) as a surrogate measure of left ventricular ejection fraction (EF) following acute myocardial infarction (AMI) and to compare its prognostic value with that of EF measured by radionuclide ventriculography (RNV). DESIGN A prospective study to compare baseline echocardiographic WMSI with RNV EF in consecutive patients thrombolysed for AMI, both performed on the same day before discharge, and their relative prognostic values in predicting cardiac events. SETTING District general hospital coronary care unit and cardiology department. PATIENTS 120 consecutive patients free of exclusion criteria thrombolysed for AMI and followed up for a mean (SD) of 13 (10) months. INTERVENTIONS None. MAIN OUTCOME MEASURES Correlation coefficients and receiver operating characteristic curve analyses plus cardiac event rates at follow up between RNV EF and echocardiographic WMSI. RESULTS WMSI correlated well with RNV EF. The best corresponding WMSIs for EFs 45%, 40%, and 35% were 0.6, 0.8, and 1.1, respectively. There were 42 cardiac events during follow up. Although both RNV EF and WMSI were strong univariate predictors of cardiac events, only WMSI independently predicted outcome in a multivariate model. All three WMSI cut offs significantly predicted events, while an RNV EF cut off of </= 45% v > 45% failed to reach significance. CONCLUSIONS Although both RNV and echocardiographic WMSI strongly predicted cardiac outcome, WMSI, a cheaper and more readily available technique, is more discriminatory, especially in cases of mild left ventricular dysfunction following AMI.
Collapse
Affiliation(s)
- G I Galasko
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | | | | | | |
Collapse
|