Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

Na Wang; Chung-Lieh Hung; Sung Hee Shin; Brian Claggett; Hicham Skali; Jens Jakob Thune; Lars Køber; Amil Shah; John J V McMurray; Marc A Pfeffer; Scott D Solomon

doi:10.1093/eurheartj/ehv558

Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

Na Wang, Chung-Lieh Hung, Sung Hee Shin, Brian Claggett, Hicham Skali, Jens Jakob Thune, Lars Køber, Amil Shah, John J V McMurray, Marc A Pfeffer, Scott D Solomon

27 Citations (Scopus)

Abstract

Aims Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. Methods and results We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q₁: -11.2%, Q₃: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. Conclusion In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.

Original language	English
Journal	European Heart Journal
Volume	37
Issue number	5
Pages (from-to)	466-472
Number of pages	7
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehv558
Publication status	Published - 2016

Keywords

Cardiovascular outcomes
Heart failure
Left ventricular dysfunction
Myocardial infarction
Regional cardiac dysfunction

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https://academic.oup.com/eurheartj/article-pdf/37/5/466/7470007/ehv558.pdf

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Wang, N., Hung, C-L., Shin, S. H., Claggett, B., Skali, H., Thune, J. J., Køber, L., Shah, A., McMurray, J. J. V., Pfeffer, M. A., & Solomon, S. D. (2016). Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction. European Heart Journal, 37(5), 466-472. https://doi.org/10.1093/eurheartj/ehv558

@article{856820dd3bd5436b9e1622d8dde31b21,

title = "Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction",

abstract = "Aims Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. Methods and results We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. Conclusion In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.",

keywords = "Cardiovascular outcomes, Heart failure, Left ventricular dysfunction, Myocardial infarction, Regional cardiac dysfunction",

author = "Na Wang and Chung-Lieh Hung and Shin, {Sung Hee} and Brian Claggett and Hicham Skali and Thune, {Jens Jakob} and Lars K{\o}ber and Amil Shah and McMurray, {John J V} and Pfeffer, {Marc A} and Solomon, {Scott D}",

year = "2016",

doi = "10.1093/eurheartj/ehv558",

language = "English",

volume = "37",

pages = "466--472",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "5",

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TY - JOUR

T1 - Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

AU - Wang, Na

AU - Hung, Chung-Lieh

AU - Shin, Sung Hee

AU - Claggett, Brian

AU - Skali, Hicham

AU - Thune, Jens Jakob

AU - Køber, Lars

AU - Shah, Amil

AU - McMurray, John J V

AU - Pfeffer, Marc A

AU - Solomon, Scott D

PY - 2016

Y1 - 2016

N2 - Aims Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. Methods and results We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. Conclusion In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.

AB - Aims Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. Methods and results We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. Conclusion In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.

KW - Cardiovascular outcomes

KW - Heart failure

KW - Left ventricular dysfunction

KW - Myocardial infarction

KW - Regional cardiac dysfunction

U2 - 10.1093/eurheartj/ehv558

DO - 10.1093/eurheartj/ehv558

M3 - Journal article

C2 - 26530103

AN - SCOPUS:84959865425

SN - 0195-668X

VL - 37

SP - 466

EP - 472

JO - European Heart Journal

JF - European Heart Journal

IS - 5

ER -

Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

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