Early echocardiographic predictors of unfavorable yearly prognosis in patients with acute myocardial infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Objective to determine the most informative in the prognostic plan echocardiographic indices in patients with acute myocardial infarction and diabetes mellitus. Methods A retrospective analysis of outcomes of 97 diabetic patients with acute myocardial infarction (AMI), with lesions of two or more coronary arteries was performed. All patients received conventional basic therapy comprising, acetylsalicylic acid, clopidogrel, beta-blocker, an ACE inhibitor, statins, and insulin therapy on a stationary phase for a minimum of 2 weeks, followed by a transition to oral antidiabetics. According to the 12 month follow depending on the outcomes two groups were established: favorable prognosis n = 46 and unfavorable prognosis n = 51, having one or more of the following complications: death, reinfarction (nonfatal), development or progression of heart failure. Results Differences in echocardiographic parameters, characterizing myocardial hypertrophy of left ventricular (LV) were revealed between patients with different outcomes of AMI. Thus, patients with adverse outcome were characterized by a significant increase of LV mass (from 191.2 ± 35.7g to 255.7 ± 46.2 g, p = 0.004) and LV posterior wall thickness (from 8.7 ± 1.04mm to 10.6 ± 1.37mm, p = 0.004) in dynamics. Moreover, a smaller LV ejection fraction (LVEF) was observed in the group with an unfavorable outcome (both initially and in dynamics), as well as large LV end-diastolic volume and end-systolic volume. Single-factor analysis has shown, that EF <40%, LV aneurysm, the involvement of the apical LV myocardial segments at any location were echocardiography predictors of poor outcome. In the group of patients with unfavorable course of AMI, the index of left atrium (LA) increased from 35.8 ± 3.8mm to 37.3 ± 1.8mm (p = 0.04), which is significantly higher than in the second group, where the LA index was 33.8 ± 3.2mm and 34.2 ± 2.9mm (p = 0.7). In the first group, the right ventricle (RV) remained practically unchanged (22.3 ± 2.7mm and 22 ± 3.5 mm, respectively, p = 0.89), while in the second group the size of the RV decreased from 23.2 ± 3.9mm to 20.7 ± 2.9mm (p = 0.38). Initially, when comparing between groups, p = 0.38) and after 1 month p = 0.5). The negative role of pressure in the pulmonary artery (PA) in patients with AMI was also demonstrated. The systolic pressure in the PA index in the group with a favorable outcome in the dynamics significantly decreased, in contrast to the group with an unfavorable outcome (from 19.9 ± 4.5 mmHg to 16.2 ± 2.6 mmHg, p = 0.03 and from 22.1 ± 5.7mmHg to 18.0 ±3.6 mmHg, p = 0.15, respectively). Conclusion AMI with a high risk of adverse 12-month outcomes, characterized by the following echocardiographic signs: engagement apical segments of the LV regardless of the localization of myocardial infarction, reduced LVEF, as well as increased PA pressure, combined with the increase in the size of RV.