TY - JOUR
T1 - Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction
AU - Brainin, Philip
AU - Haahr-Pedersen, Sune
AU - Sengeløv, Morten
AU - Olsen, Flemming Javier
AU - Fritz-Hansen, Thomas
AU - Jensen, Jan Skov
AU - Biering-Sørensen, Tor
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1-3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.
AB - Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1-3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.
KW - Aged
KW - Biomechanical Phenomena
KW - Chi-Square Distribution
KW - Echocardiography, Doppler, Color
KW - Echocardiography, Doppler, Pulsed
KW - Female
KW - Heart Failure/diagnostic imaging
KW - Humans
KW - Image Interpretation, Computer-Assisted
KW - Kaplan-Meier Estimate
KW - Linear Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Myocardial Contraction
KW - Percutaneous Coronary Intervention/adverse effects
KW - Predictive Value of Tests
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/complications
KW - Stroke Volume
KW - Time Factors
KW - Treatment Outcome
KW - Ventricular Function, Left
U2 - 10.1007/s10554-017-1288-7
DO - 10.1007/s10554-017-1288-7
M3 - Journal article
C2 - 29230597
SN - 1569-5794
VL - 34
SP - 751
EP - 760
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 5
ER -
