Predictive prognosis value of echocardiographic risk score after acute coronary syndromes

Abstract

The stratification of the risk of a major cardiovascular event after an acute coronary syndrome by Doppler echocardiography provides prognostic support to the different clinical models and allows a non-invasive evaluation of the risk, independent of comorbidities. The echoscore provides a better definition of the categories of high-risk and intermediate patients for whom a more aggressive approach improves outcomes. The aim of our study is to identify the echocardiographic parameters predictive of major cardiovascular events (death, reinfarction and rehospitalisation) in the acute phase and after six months of follow-up after acute coronary syndrome. We recruited 302 patients (215 men, age 63 ± 12 years) who had been admitted for ACS (151 [50%] with STEMI, 108 [35.8%] with NSTEMI and 43 [14.2%] with unstable angina). Patients were assessed by resting echocardiography. A follow-up of six months of all patients. The echocardiographic variables significant after a binary logistic regression that are independent predictors of hard event: LVEF (RR = 0.931; 95% CI = 0.885–0.979, P < 0.01), RV-FA (RR = 0.951; 95% CI = 0.903–0.999, P < 0.05), iMAE-M-strain (RR = 1.226; 95% CI = 1.081–1.390, P < 0.01) and ULCs (RR = 1.151; 95% CI = 1.081–1.224, P < 0.01). The echocardiographic model is the sum of scores of the 4 variables selected (from 4 points for low risk with a probability for major cardiovascular event 3.4%, up to 16 points for high-risk with a probability of 15.1%). This score has good prognosis accuracy (AUROC = 0.85) and it retains good (AUCROC = 0.80) when testing on the validation cohort. The developed echocardiographic model could prove very useful in the decision-making process and optimisation of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.