Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a high risk of mortality after acute ST-segment elevation myocardial infarction (STEMI). We compared STEMI patients with versus without COPD in terms of infarct size and left ventricular (LV) systolic function using advanced 2-dimensional speckle tracking echocardiography. Of 1,750 patients with STEMI (mean age 61 ± 12 years, 76% male), 133 (7.6%) had COPD. With transthoracic echocardiography, left ventricular ejection fraction (LVEF) and wall motion score index were measured. Infarct size was assessed using biomarkers (creatine kinase and troponin T). LV global longitudinal strain (GLS), reflecting active LV myocardial deformation, was measured with 2-dimensional speckle tracking echocardiography to estimate LV systolic function and infarct size. STEMI patients with COPD were significantly older, more likely to be former smokers, and had worse renal function compared with patients without COPD. There were no differences in infarct size based on peak levels of creatine kinase (1315 [613 to 2181] vs 1477 [682 to 3047] U/l, p = 0.106) and troponin T (3.3 [1.4 to 7.3] vs 3.9 [1.5 to 7.8] µg/l, p = 0.489). Left ventricular ejection fraction (46% vs 47%, p = 0.591) and wall motion score index (1.38 [1.25 to 1.66] vs 1.38 [1.19 to 1.69], p = 0.690) were comparable. In contrast, LV GLS was significantly more impaired in patients with COPD compared with patients without COPD (-13.9 ± 3.0% vs -14.7 ± 3.9%, p = 0.034). In conclusion, despite comparable myocardial infarct size and LV systolic function as assessed with biomarkers and conventional echocardiography, patients with COPD exhibit more impaired LV GLS on advanced echocardiography than patients without COPD, suggesting a greater functional impairment at an early stage after STEMI.
Highlights
Infarct size and left ventricular (LV) systolic function acutely after segment elevation myocardial infarction (STEMI)
The present study demonstrates that STEMI patients with concomitant chronic obstructive pulmonary disease (COPD) have more impaired LV systolic function and larger infarct area based on LV global longitudinal strain (GLS) compared with patients without COPD, despite having similar infarct size as assessed with cardiac biomarkers
These findings suggest that STEMI patients with COPD have greater impairment of LV systolic function at an early stage after STEMI
Summary
Infarct size and LV systolic function acutely after STEMI. LV ejection fraction (EF) and wall motion score index (WMSI) are commonly used in clinical practice to estimate LV systolic function and for risk stratification of patients with STEMI.[5,6] these conventional echocardiographic parameters may not be sensitive enough to characterize the extent of myocardial damage after STEMI.[7,8] Two-dimensional (2D) speckle tracking echocardiography global longitudinal strain (GLS), reflecting active deformation of the LV myocardium, has emerged as a valuable index of LV systolic function and infarct size.[9]. The present study aimed at evaluating the differences in infarct size and systolic function in STEMI patients with versus without COPD by measuring biomarkers (creatine kinase [CK] and troponin T) as well as conventional and advanced 2D speckle tracking echocardiography
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