PP.24.22] HIGHER PULSE WAVE VELOCITY IS ASSOCIATED WITH NON-RECOVERY OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN PATIENTS AFTER MYOCARDIAL INFARCTION

Abstract

Objective: Functional recovery or irreversible negative remodeling of injured myocardial segments has different prognostic implication in patients with myocardial infarction (MI) undergoing coronary percutaneous intervention (PCI). Increased pulse wave velocity (PWV),is one of the important risk factors of cardiovascular events in different clinical conditions. The aim of the study was to assess the relationship between PWV and changes of left ventricular (LV) systolic function in patients with acute MI. Design and method: In 112 patients with acute MI and PCI (68% male,age 61.1 ± 9.5 years (M ± SD),57.2% with ST-elevation MI (STEMI),smokers 35%,arterial hypertension 83%,diabetes 7%,blood pressure (BP) 128 ± 8/82 ± 87mmHg, LV ejection fraction (LVEF) 48.2 ± 4.6%). Arterial stiffness was assessed using applanation tonometry. Global longitudinal peak strain (GLPS) by speckle tracking echocardiography (STE) was calculated in a 16-segment LV model as the average segmental value on the basis of three apical imaging planes. Cardiac adverse remodeling was defined by ratio [follow up - initial LV end diastolic volume (LVEDV)] / initial LVEDV) more than 20%. Mann-Whitney and Spearman tests were considered significant if p < 0.05. Results: Baseline GLPS >20% was not detected in any patient. GLPS increased from 14.4 ± 2.4 to 17.4 ± 3.5% in 4 weeks (p < 0.05) and to 18.1 ± 2.7 in 6 months after PCI (p < 0.05). GLPS normalized (>20%) in 31 (28%) patients after 4 weeks and 6 months. After 6 months adverse cardiac remodeling was found in 81 (72%) patients (53% STEMI). Achieved GLPS differed significantly in patients with vs without adverse cardiac remodeling (16.7 ± 1.9 vs 21.4 ± 1.2%, p < 0.001). Mean carotid-femoral PWV decreased from 11.1 ± 2.1 to 8.7 ± 1.8 m/s,p < 0.05. Patients without vs with GLPS normalization in 6 months after PCI were older (62.5 ± 8.5 vs 60.6 ± 9.9 years, p < 0.05), more frequent male (71vs 66.2%, χ2 = 11.1;p < 0.05),smokers (36.2vs 31.2%, χ2 = 3.4;p < 0.04),STEMI (58.7vs 53%, χ2 = 7.7; p < 0.05),had higher systolic BP (134 ± 10vs 130 ± 6 mmHg, p < 0.03),baseline PWV (11.4 ± 1.9vs 10.4 ± 2.6 m/s, p < 0.03),lower baseline EF (47.6 ± 4.9 vs 49.6 ± 3.5%, p < 0.05). A significant correlation was found between decreased δspeckle tracking and higher PWV (r = −0.31,p < 0.05) and speckle tracking and LVEDV after 6 months (r = −0.75,p < 0.05). Conclusions: 65% of patients with MI treated with PCI failed to normalize GLPS after 6 months. Adverse cardiac remodeling was revealed in 72% of patients and they more often had non-recovery of left ventricular longitudinal function. Higher baseline PWV is associated with less effective recovery of LV function.