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

Y1 - 2018/5

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

VL - 34

SP - 751

EP - 760

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

IS - 5

ER -