Abstract
It has been shown that the E/(e’×s’) index, which associates a marker of diastolic function (E/e’, early transmitral/diastolic mitral annulus velocity ratio) and a parameter that explores LV systolic performance (s’, systolic mitral annulus velocity), is a good predictor of outcome in acute anterior myocardial infarction. There are no studies that have investigated the prognostic value of E/(e’×s’) in a non-ST-segment elevated acute coronary syndrome (NSTE-ACS) population. Echocardiography was performed in 307 consecutive hospitalized patients with NSTE-ACS and succesful percutaneous coronary intervention, before discharge and six weeks after. The primary endpoint consisted of cardiac death or readmission due to re-infarction or heart failure. During the follow-up period (25.4 ± 3 months), cardiac events occurred in 106 patients (34.5%). Receiver operating characteristic (ROC) analysis identified E/(e’×s’) at discharge as the best independent predictor of composite outcome. The optimal cut-off value was 1.63 (74% sensitivity, 67% specificity). By multivariate Cox regression analysis, E/(e’×s’) was the only independent predictor of cardiac events. Kaplan–Meier analysis identified that patients with an initial E/(e’×s’) > 1.63 that worsened after six weeks presented the worst prognosis regarding composite outcome, readmission, and cardiac death (all p < 0.001). In conclusion, in NSTE-ACS, E/(e’×s’) is a powerful predictor of clinical outcome, particularly if it is accompanied by worsening after 6-weeks.
Highlights
Patients admitted to hospital because of an acute coronary syndrome (ACS) constitute a heterogeneous population with a varying risk of future cardiac events [1,2]
We demonstrated the utility of this index to assess the left ventricular (LV) filling pressure in a heterogeneous population of cardiac patients, regardless of LV ejection fraction (LVEF) [11] and to improve the prediction of cardiac events in patients with heart failure (HF) [12]
In the period of November 2017 to January 2019, 307 consecutive patients hospitalized for NSTE-ACS who underwent successful percutaneous coronary intervention (PCI) were included in this prospective study
Summary
Patients admitted to hospital because of an acute coronary syndrome (ACS) constitute a heterogeneous population with a varying risk of future cardiac events [1,2]. Non-STsegment elevated acute coronary syndrome (NSTE-ACS) is a significant contributor to both morbidity and mortality, accounting for almost half of all deaths related to cardiovascular disease [3,4]. Risk stratification is important to identify patients who may benefit from an intensified treatment strategy [1,4] and it helps prevent unnecessary re-admissions to the hospital [4]. Prior to the clinical symptoms of heart failure (HF) becoming clear, patients can develop asymptomatic LV dysfunction caused by structural or functional cardiac abnormalities [2]. Ischemia with subsequent impairment of myocardial contractility and myocardial damage are related to increased LV filling pressure [6]
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