Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study

TY - JOUR

T1 - Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction

T2 - a two-dimensional speckle-tracking study

AU - Ersbøll, Mads

AU - Andersen, Mads J

AU - Valeur, Nana

AU - Mogensen, Ulrik M

AU - Fahkri, Yama

AU - Thune, Jens J

AU - Møller, Jacob E

AU - Hassager, Christian

AU - Søgaard, Peter

AU - Køber, Lars

PY - 2014/3

Y1 - 2014/3

N2 - AimsDiastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e′sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value of this measure has not been demonstrated in a large-scale setting when existing parameters of diastolic function are known. We hypothesized that the E/e′sr ratio would be independently associated with an adverse outcome in patients with MI.Methods and resultsWe prospectively included patients with MI and performed echocardiography with comprehensive diastolic evaluation including E/e′sr. The relationship between E/e′sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke, and new onset atrial fibrillation) was analysed with Cox models. A total of 1048 patients (mean age 63 ± 12, 73% male) were included and 142 patients (13.5%) reached the primary endpoint (median follow-up 29 months). A significant prognostic value was found for E/e′sr [hazard ratio (HR) per 1 unit change: 2.36, 95% confidence interval (CI): 2.02-2.75, P < 0.0001]. After multivariable adjustment E/e′sr remained independently related to the combined endpoint (HR per 1 unit change, 1.50; CI: 1.05-2.13, P = 0.02). The prognostic value of E/e′sr was driven by mortality (HR per 1 unit change, 2.52; CI: 2.09-3.04, P < 0.0001) and HF admissions (HR per 1 unit change, 2.79; CI: 2.23-3.48, P < 0.0001).ConclusionDeformation-based E/e′sr contributes important information about global myocardial relaxation superior to velocity-based analysis and is independently associated with the outcome in acute MI.

AB - AimsDiastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e′sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value of this measure has not been demonstrated in a large-scale setting when existing parameters of diastolic function are known. We hypothesized that the E/e′sr ratio would be independently associated with an adverse outcome in patients with MI.Methods and resultsWe prospectively included patients with MI and performed echocardiography with comprehensive diastolic evaluation including E/e′sr. The relationship between E/e′sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke, and new onset atrial fibrillation) was analysed with Cox models. A total of 1048 patients (mean age 63 ± 12, 73% male) were included and 142 patients (13.5%) reached the primary endpoint (median follow-up 29 months). A significant prognostic value was found for E/e′sr [hazard ratio (HR) per 1 unit change: 2.36, 95% confidence interval (CI): 2.02-2.75, P < 0.0001]. After multivariable adjustment E/e′sr remained independently related to the combined endpoint (HR per 1 unit change, 1.50; CI: 1.05-2.13, P = 0.02). The prognostic value of E/e′sr was driven by mortality (HR per 1 unit change, 2.52; CI: 2.09-3.04, P < 0.0001) and HF admissions (HR per 1 unit change, 2.79; CI: 2.23-3.48, P < 0.0001).ConclusionDeformation-based E/e′sr contributes important information about global myocardial relaxation superior to velocity-based analysis and is independently associated with the outcome in acute MI.

KW - Blood Flow Velocity

KW - Diastole

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Prognosis

KW - Prospective Studies

KW - Stress, Physiological

KW - Systole

KW - Ventricular Dysfunction, Left

U2 - 10.1093/eurheartj/eht179

DO - 10.1093/eurheartj/eht179

M3 - Journal article

C2 - 23713080

SN - 0195-668X

VL - 35

SP - 648

EP - 656

JO - European Heart Journal

JF - European Heart Journal

IS - 10

ER -