Echocardiographic Parameters Predict Short- and Long-Term Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction

Effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and structural changes following myocardial infarction: A systematic review and meta-analysis

BACKGROUND

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are anti-hyperglycemic drugs and have been proven to have cardiovascular protective effects for patients with heart failure regardless of their diabetes status. However, the benefit of SGLT2i following myocardial infarction (MI) remains incompletely established. This review aimed to investigate the impact of SGLT2i on NT-proBNP levels and structural changes post-MI.

METHOD

Medline, ClinicalTrial.gov, Scopus, and Directory of open-access journals were searched to retrieve the relevant articles. Eligible studies were randomized clinical trials that assessed NT-proBNP and cardiac structural changes in patients who received SGLT2i compared to placebo following MI. Two reviewers independently screened articles, extracted data, and assessed study quality.

RESULT

Four studies were included in this review, including patients with and without diabetes. While two studies showed no marked decrease from the baseline in NT-proBNP levels between the SGLT2i group and the control group, two studies reported a substantial reduction. The meta-analysis included three of these studies, with a total of 238 participants. The meta-analysis did not find a statistically significant drop in NT-proBNP levels post-MI in the SGLT2 inhibitors group compared to placebo (pooled SMD = 0.16, 95% CI 0.57-0.26, P 0.45). Furthermore, different echocardiographic parameters were reported in the included trials, yet no meta-analysis could be conducted to assess the influence of SGLT2i on cardiac remodeling post-MI.

CONCLUSION

SGLT2i did not result in a statistically significant reduction of NT-proBNP level subsequent to myocardial infarction. A knowledge gap exists regarding the impact of these agents on cardiac remodeling post-MI. Future high-quality clinical trials are needed to provide more robust evidence.

Using ultrasound radiomics to forecast adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention

OBJECTIVE

Exploring the performance of ultrasound-based radiomics in forecasting major adverse cardiovascular events (MACE) within 1 year following percutaneous coronary intervention (PCI) of acute coronary syndrome (ACS) patients.

METHODS

In this research, 161 ACS patients who underwent PCI were included (114 patients were randomly assigned to the training set and 47 patients to the validation set). Every patient received echocardiography 3-7 days after PCI and followed up for 1 year. The radiomics features related to MACE occurrence were extracted and selected to formulate the RAD score. Building ultrasound personalized model by incorporating RAD score, LVEF, LVGLS, and NT-ProBNP. The model's capacity to predict was tested using ROC curves.

RESULTS

Multifactorial logistic regression analysis of RAD score with clinical data and echocardiographic parameters indicated RAD score and LVGLS as independent risk factors for the occurrence of MACE. The RAD score predicted MACE, with AUC values of 0.85 and 0.86 in the training and validation sets. The ultrasound personalized model had a superior ability to predict the occurrence of MACE, with AUC values of 0.88 and 0.92, which were higher than those of the clinical model (with AUC of 0.72 and 0.80) without RAD score (Z = 3.711, 2.043, P < .001, P = .041). Furthermore, DCA indicated that the ultrasound personalization model presented a more favorable net clinical benefit.

CONCLUSIONS

Ultrasound radiomics can be a reliable tool to predict the incidence of MACE after PCI in patients with ACS and provides quantifiable data for personalized clinical treatment.

Global longitudinal strain and the risk of major adverse cardiac events in post-myocardial infarction patients: A retrospective cohort study

BACKGROUND

This study evaluates the relationship between global longitudinal strain (GLS) and late major adverse cardiovascular events (MACEs) in patients after acute myocardial infarction (AMI).

METHODS

Data of newly diagnosed AMI patients between March 2010 and July 2014 were retrospectively evaluated. The patients underwent serial echocardiography at admission and at third and sixth months post-admission. We calculated GLS by averaging the strain from all myocardial segments using speckle-tracking echocardiography (STE). We used multivariate Cox regression analysis and receiver operating characteristic (ROC) curve analyses to assess the relationship between GLS at admission and late MACEs.

RESULTS

Eighty-nine newly diagnosed AMI patients were enrolled. The average age at diagnosis was 61 ± 12.5 years, and approximately 89.9% of the patients were men. The average level of GLS was -17.5 ± 3.9%. The overall prevalence of MACEs was 23.6% (21/89), compared with 44% (11/25) in the group with GLS≥-15% and 17.9% (5/28) in the group with GLS<-20%. GLS was positively linked with MACEs in the fully adjusted Cox proportional hazard model (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.04-1.37; P=0.014) after adjusting potential confounders. The ROC curve analysis for one year MACEs between GLS at admission, with the most significant area under the curve(AUC) 78.1% (95% CI, 63.8% - 92.6%).

CONCLUSIONS

Myocardial dysfunction, characterized by impaired GLS, is often observed in AMI patients, and a decrease in GLS levels at admission were associated with an increased risk of long-term MACEs in post-myocardial infarction patients.

Ten-year predictors of major adverse cardiovascular events in patients without angina

BACKGROUND

Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina.

METHODS

Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality.

RESULTS

There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780).

CONCLUSION

Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality.Contribution: Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.

Angiographic Coronary Calcification: A Simple Predictor of Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

AIMS

Coronary calcification detected by coronary angiography is a simple risk marker for long-term clinical outcomes in stable coronary artery disease. However, the significance of angiographic coronary calcification in the culprit lesion of acute myocardial infarction (AMI) has not been fully discussed. The purpose of this retrospective study was to assess the usefulness of angiographic coronary calcification as a risk marker for long-term clinical outcomes following percutaneous coronary intervention to the culprit lesions of AMI.

METHODS

We included 1209 patients with AMI and divided them into the none-mild calcification group (n=923) and the moderate-severe calcification group (n=286) according to angiographic coronary calcification in the culprit lesion of AMI. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, nonfatal MI, readmission for heart failure, and ischemia-driven target vessel revascularization.

RESULTS

The median follow-up duration was 542 (Q1: 182, Q3: 990) days. A total of 345 MACE were observed during the study period. The occurrence of MACE was significantly greater in the moderate-severe calcification group than in the none-mild calcification group (43.4% vs. 23.9%, p＜0.001). In the multivariate Cox hazard model, moderate-severe calcification was significantly associated with MACE (hazard ratio 1.302, 95% confidence interval 1.011-1.677, p=0.041) after controlling multiple confounding factors.

CONCLUSIONS

Angiographically moderate to severe calcification in AMI culprit lesion was associated with long-term worse clinical outcomes. Angiographic coronary calcification can be a simple risk marker in patients after AMI.

Association of Left Ventricular Systolic Function with Diagonal Branch Flow in Patients with First Anterior ST-Elevation Myocardial Infarction Treated with Primary Angioplasty

Background: There are few studies about the impact of diagonal branch blood flow on echocardiographic findings in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Objectives: We aimed to compare left ventricular systolic function measures in patients with first acute anterior ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty based on diagonal branch blood flow after the procedure. Methods: This study was a single-center study that enrolled patients with their first acute anterior STEMI treated with primary angioplasty in our center between October 2020 and March 2021. Patients were divided into two groups: The patients with final thrombolysis in myocardial infarction (TIMI) flow III in diagonal (sufficient diagonal flow) and patients with final TIMI flow less than III in diagonal (insufficient diagonal flow) after the procedure. The left ventricular Wall-Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: A total of 107 patients with first anterior STEMI treated with primary PCI were enrolled in the present study, of which 13 patients (12.1%) had insufficient diagonal flow after primary coronary angioplasty. The LVEF was lower in patients with insufficient diagonal flow (32.92 ± 7.29% vs. 39 ± 8.68%, P = 0.018). Also, this group had higher LV WMSI (1.68 ± 0.28 vs. 1.49 ± 0.26, P = 0.029). Conclusions: The present study showed that in patients with first acute anterior STEMI undergoing primary angioplasty, insufficient diagonal branch flow after the procedure was associated with worse left ventricular systolic function and higher LV WMSI.

Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study population were 150 consecutive patients treated for acute myocardial infarction. Results: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p=0,07), number of diseased vessels (p=0,027), and need for loop diuretic therapy (p=0,050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors. Keywords: myocardial infarction, cardiac biomarkers, cardiac troponin, natriuretic peptide, prognosis, major adverse cardiac events (MACE), cardiac death

Evaluation of the Prognostic Role of the Wall Motion Score Index and the SYNTAX Score II in Patients with Acute Coronary Syndrome Following Percutaneous Coronary Intervention by Evaluation of Major Adverse Cardiovascular Events at 12-Month Follow-Up

Background

This study aimed to evaluate the wall motion score (WMS) index and the SYNTAX score II (SSII) in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) by evaluation of major adverse cardiovascular events (MACEs) at the 12-month follow-up at a single center.

Material/Methods

An observational study of 430 patients with ACS undergoing PCI at the Second Affiliated Hospital of Soochow University over a 1-year period was performed. Baseline data including WMS and SSII were recorded and compared with the rates of MACEs in the study group. WMS and SSII were stratified by the tercile from low to high.

Results

Both WMS and SSII were associated with the rates of MACEs (P<0.001 and P=0.003, respectively). The incidence of MACEs was positively correlated with terciles of the WMS and SSII groups (3.7% vs 1.6% vs 7.0% [P<0.001] and 2.6% vs 5.8% vs 11.6% [P<0.001], lowest to highest, respectively). Logistic regression analyses identified combined predictors for 12-month outcome, including WMS and SSII. The use of a model combining both scores yielded a higher predictive value (area under the curve [AUC]=0.78; 95% confidence interval [CI], 0.733–0.835; P<0.001) than the use of either score alone. Using WMSs alone, the AUC was 0.73 (95% CI, 0.660–0.793; P<0.001). Using SSII alone, the AUC was 0.71 (95% CI, 0.649–0.769; P<0.001).

Conclusions

This study showed that the combined methods of the WMS index and the SSII were predictive factors of MACEs in patients with ACS following PCI at the 12-month follow-up.