Abstract
The aim is to determine whether serial post-systolic shortening (PSS) using speckle tracking echocardiography (STE) could predict major adverse cardiovascular events (MACE), especially symptom-driven infarct-related artery (IRA) revascularization and improvement in segmental function in post-myocardial infarction patients. Ninety-four patients (average age 61.1 ± 12.5 y, 84 [84.9%] male) with new-onset acute myocardial infarction were enrolled. Serial echocardiography was performed during the initial presentation, and at 3, 6 and 12 months after admission. PSS, strain and systolic strain rate were calculated using STE. Improvement in segmental function was defined as a decrease of ≧1 grade in wall motion score. During the follow-up (29.4 ± 12.7months), 22 patients (23.4%) had MACE and 17 patients had symptom-driven IRA revascularization. In multivariate model, PSS at 3 months was independently predictive for symptom-driven IRA revascularization (Hazard ratio (HR) = 0.5, 95% CI = 0.26-0.97) and for MACE (HR = 0.4, 95% CI = 0.24-0.67) (p < 0.05). Segmental function improvements were found in 255 segments (66.1%) and ROC curve analyses showed that AUC (95% CI) of the initial PSS was 0.7(0.65-0.77) (cut-off values = -1.08, sensitivity = 58%, specificity = 73% specificity). Post-systolic shortening at 3 months is an independent predictor for symptom-driven IRA revascularization and MACE. Regional wall motion recovery also could be predicted by initial PSS. Serial assessment of two-dimensional STE should be investigated in post-myocardial infarction patients in the future.
Highlights
Risk assessment is important for patients with post-myocardial infarction, due to the risk of major adverse cardiovascular events (MACE) and mortality even after percutaneous coronary intervention (PCI)
Post-systolic shortening at 3 months is an independent predictor for symptom-driven infarct-related artery (IRA) revascularization and MACE
Previous studies have reported that the diagnostic accuracy of 2D speckle tracking echocardiography (STE) for restenosis is lower in territories of infarction [4,5,6]
Summary
Risk assessment is important for patients with post-myocardial infarction, due to the risk of major adverse cardiovascular events (MACE) and mortality even after percutaneous coronary intervention (PCI). Postsystolic shortening (PSS) is defined as persistent shortening beyond aortic valve closure. It has been observed in cases of acute and chronic ischemic diseases and has been reported as a predictor of viability [7,8,9] or ischemia memory which could persist longer than the decrease in peak systolic strain [10]. Relatively few studies have evaluated the prognostic value of PSS in MACE, and infarct-related artery (IRA) revascularization among patients with post-myocardial infarction. Our objective in the current study was to assess serial PSS using 2D STE and thereby determine its value in predicting MACE after myocardial infarction and symptom-driven IRA revascularization. We evaluated its capacity to predict improvement in segmental myocardial function
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