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GW27-e0200 Serial assessment of calcification 5 years after bioresorbable vascular scaffold implantation: fusion of intravascular ultrasound and optical coherence tomography
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
CORONARY INTERVENTION GW27-e0101 Impact of thrombus aspiration versus direct stenting on outcome of patients with primary percutaneous coronary intervention Rama Kumari,1 Radhika S,1 Aruna devi M,1 Bhaskaraju,2 Sai Satish,1 LSR Krishna1 1 Nizam’s institute of medical sciences; 2Gandhi medical college OBJECTIVES Aim of the study is to describe the impact of routine aspiration thrombectomy with PCI versus PCI alone in patients with STEMI. To study the post procedural outcomes post PCI TIMI flow and long term mortality. METHODS Study population: patients with symptom onset < 12 hours and atleast 1mm ST elevation in 2 > contiguous limb leads or atleast 2 mm ST elevation in 2> contiguous precordial leads or LBBB are considered for PPCI. They are divided into 2 groups, PCI alone and PCI with thrombectomy group. Study outcomes: The primary efficacy outcome was death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA class IV heart failure within 180 days. Key secondary outcome was cardiovascular deaths, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA class IV heart failure, stent thrombosis or target-vessel revascularization within 180 days. Statistical analysis: Primary and secondary outcomes are analyzed by cox regression analysis and hazard ratios for the events were compared between two groups. Kaplan meier estimates for the primary outcome was done in PCI alone and thrombectomy group within 180 days after the procedure. RESULTS In this study, 84 patients were included of whom 53 underwent PCI alone and 31 underwent thrombus aspiration plus PCI. The mean age was 57.3 10 and 55.8 11.2 in PCI alone and thrombectomy group respectively.The rate of the primary outcome in patients who underwent PCI for index STEMI was 18.8% in the PCI-alone group was 9.67% in the thrombectomy group (hazard ratio for the thrombectomy group as compared with PCI alone group was 1.94; 95% confidence interval [CI], 0.46 to 8.03; P ¼ 0.36). The secondary outcome occurred in 33.96% of patients in PCI alone group and 25.8% of patients in thrombectomy group (hazard ratio 1.33; 95% CI 0.573.05 with p value of 0.5). Subgroup analysis of the study done for the occurrence of the primary outcome within 180 days, revealed that the patients with initial TIMI thrombus grade 3, anterior wall MI and symptom onset < 6hrs had a higher risk of mortality in PCI alone group when compared to thrombectomy group however it was not statistically significant. (HR 2.00; 95% CI 0.4-10; p¼0.41, HR 2.5; 95% CI 0.5-11.7; p¼0.25, HR 3.76; 95%CI 0.4-33.7; p¼0.24 respectively). In our study, two patients suffered from stroke, one in each group. Kaplan meier analysis demonstrated that there was no statistically significant difference in time to death between the 2 groups over a period of 180 days. CONCLUSIONS In our study, patients who were undergoing primary PCI, there was 94% higher risk of death within 180 days in PCI alone group when compared to thrombectomy group. In patients with higher initial TIMI thrombus grade or anterior wall MI or symptom onset less than 6 hrs had higher risk of death with PCI alone as compared with thrombectomy. Our study demonstrates that thrombus aspiration followed by PCI yields better clinical outcomes in such cases.
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into 3 groups according to their C-ACS scores: Group 1, score 0; Group 2, score 1; and Group 3, score 2. The primary outcomes were the development of CIN and major clinical adverse events (MACEs). RESULTS Overall, 33 patients (8.4%) developed CIN. Patients with high C-ACS risk scores were more likely to develop CIN (2.8%, 10.3%, 26.4% for C-ACS score 0; 1; 2, respectively, p< 0.001), as well with the in-hospital death and MACEs. After adjusting for potential confounding predictors, C-ACS risk scores remained significantly associated with CIN (OR¼2.87, 95%CI, 1.78-4.63, p < 0.001). ROC showed that C-ACS risk scores has good predictive values for CIN, in-hospital morality, MACEs and long-term mortality (C statistic¼0.751, 0.712, 0.628, respectively). In addition, patients with high C-ACS risk scores exhibited a worse survival rate than patients with low risk scores (Death, p¼0.02; MACEs, p¼0.006). Furthermore, the C-ACS risk score was independently associated with the long-term MACEs (hazard ratio ¼1.30, 95% CI¼1.04-1.64, p¼0.022). CONCLUSIONS C-ACS risk score can be simply used to predict CIN and to stratify patients for poor clinical outcomes both in the shortand long-term follow-up in patients with STEMI before primary PCI. GW27-e0184 9 months clinic results of drug-coating balloons (DCB) in single center real-work of China Zhang Wenduo, Yu Xue, Wang Xinyue, Fukui Ji Beijing Hospital OBJECTIVES Drug coating balloon (DCB) is a new therapeutic option for treatment of obstructive coronary lesions in percutaneous coronary intervention (PCI). There is limited data on the safety and efficacy of DCB in China patients in contemporary clinical registries. We aim to evaluated the clinical efficacy and safety of SeQuent Please paclitaxel-coating balloon in our single center patients in real world clinical practice. METHODS Between August 2014 to March 2015, 80 patients (51% male, mean age 66 10 years) with a total of 85 coronary lesions were treated with SeQuent Please DCB. The primary endpoint was major adverse cardiac events (MACE) composite of cardiovascular death, target vessel related myocardial infarction (MI) and target lesion revascularization (TLR) at 9 months follow-up. RESULTS The majority of patients presented with acute coronary syndrome (76%). An average DCB diameter was 2.70.45 mm and average total length was 15.83.9 mm. At 9 months’ follow-up, 3.75% of patients developed MACE. MACE was mainly driven by TLR(1.25%) followed by target vessel related myocardial infarction (1.25%) and cardiovascular death (2.5%). CONCLUSIONS SeQuent Please DCB was a safe and effective treatment modality in our single center Chinese patients with a low incidence of MACE observed at 9 months follow-up. GW27-e0200 Serial assessment of calcification 5 years after bioresorbable vascular scaffold implantation: fusion of intravascular ultrasound and optical coherence tomography Zeng Yaping,1 Patrick W. Serruys2 1 The Emergency & Critical Care Center of Beijing Anzhen Hospital, Capital Medical University, Beijing, the People’s Republic of China; 2 International Centre for Circulatory Health, Imperial College, London, United Kingdom
GW27-e0160 A new simple pre-procedure risk score for early predicting contrastinduced nephropathy and long-term outcomes in patients undergoing primary percutaneous coronary intervention
OBJECTIVES To assess calcium growth with fused greyscale-IVUS, virtual histology-IVUS (VH-IVUS) and OCT from baseline to 5-year follow-up in patients treated with Bioresorbable Vascular Scaffolds (BVS).
Liu Yuanhui, Yong Liu, Ji-yan Chen, Ning Tan Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Ac
METHODS Anatomic landmarks and endoluminal radiopaque markers were used to fuse OCT and IVUS images and match baseline and follow-up.
OBJECTIVES Contrast-induced nephropathy (CIN) is a common complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may cause increased morbidity and mortality. We aimed to evaluate the predictive value of Canada Acute Coronary Syndrome (C-ACS) risk score for CIN in STEMI patients before primary PCI, allowing pre-procedural decisions regarding prevention therapy for CIN. METHODS A total of 394 consecutive patients with STEMI undergoing primary PCI enrolled in this study. The study patients were divided
RESULTS Seventy-two VH-IVUS and OCT paired matched crosssection in- and out-scaffold segments were fused at baseline and follow-up. In total, 46 calcified plaques at follow-up were detected by the fusion method (33 in-,13 out-scaffold), showing either calcium progression (52.2%) or de novo calcifications(47.8%). On OCT, calcification volume increased from baseline to follow-up by 2.32.4mm3 (p¼0.001). The baseline VH tissue precursors of dense calcium(DC) at follow-up were necrotic core(NC)in 73.9% and Fibrous/ Fibrofatty (F/FF) in 10.9%. In 15.2%, calcium was already present at baseline. Precursors on OCT were lipid pool in 71.2%, fibrous in 4.3%, and fibrocalcific plaque in 23.9%.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
CONCLUSIONS The use of OCT/IVUS fusion imaging shows similar calcium growth in-and out-scaffold segments. NC is the most frequent precursor of calcification. The scaffold resorption process creates a tissuelayer that recaps the calcified plaques. GW27-e0206 Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index: a clinical follow-up study Hu Bo, Ruiqiang Guo renmin hospital of wuhan university OBJECTIVES Segmental wall motion dysfunction after acute myocardial infarction (AMI) has led to progressing left ventricular remodeling (LVR), which has gradually worsened cardiac function of AMI patients with poor prognosis. Our study sought to explore the prognostic value of speckle tracking imaging (STI) for LVR in AMI patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI). METHODS 83 patients with first onset AMI were enrolled from Jan 2012 to May 2015 and underwent echocardiography within 24hs of the infarcted onset (baseline) and at 6-month follow-up. LVR was defined as the percentage change of left ventricular end-diastolic volume (DLVEDV%) from baseline to 6-month follow-up was more than 20% (divided as LVR and non-LVR group). Standard long-axis and shortaxis views were stored and analyzed for longitudinal (LS), radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI. Segments of WMSI2 were selected and calculated for the mean values of LS (LS_WMSI), RS (RS_WMSI) and CS (CS_WMSI). RESULTS LVR occurred in 27 AMI patients at 6-month follow-up. No difference has shown for demographics, electrocardiogram, lab tests, coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline, while all STI metrics were found statistical difference for the comparisons (P＜0.05, all), especially the WMSI selected STI metrics (P＜0.001, all). Linear regression analysis demonstrated that CS_WMSI (r¼0.716，P＜0.001) was the best correlated to DLVEDV% among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6%, specificity of 87.5% and area under the curve of 0.9563).
CONCLUSIONS Speckle tracking echocardiography has the strong power for positive and negative prediction of HF and LVR after myocardial infarction. Metrics of longitudinal strain as minimum segmental strain and change rate of strain were optimal for the prediction of HF as well as the corresponding metrics of circumferential strain for the prediction of LVR. GW27-e0213 Assessment of the left ventricular layer-specific strain in patients with Non-ST Segment elevation acute myocardial infarction by 2-dimensional speckle-tracking echocardiography Zhu Jingjing, Ruiqiang Guo renmin hospital of wuhan university OBJECTIVES We sought to discuss the clinical value of 2D-STE for the identification of NSTEMI by assessing left ventricular layer-specific strain in patients with NSTEMI. METHODS Sixty patients due to suspected AMI, divided into two groups based on electrocardiogram (ECG), NSTEMI group containing 30 patients, STEMI group containing 30 patients, and thirty age and gender matched subjects were involved as the control group. Layer-specific global longitudinal and circumferential strains (GLS and GCS) were assessed at endocardium, midmyocardium and epicardium by 2D-STE, so were territorial longitudinal and circumferential strains(TLS and TCS). The absolute differences between endocardial and epicardial GLS, GCS, infarcted segments TLS, TCS (DGLS, DGCS, DTLS, DTCS) were calculated . RESULTS ① Left ventricular segments of patients from NSTEMI group and STEMI group were divided into normal segments and Infarcted segments based on the selective coronary arteriography(SCA). ②Patients with NSTEMI and STEMI had low value in all 3 myocardial layers assessed by GLS, DGLS and infarcted segments TLS, DTLS compared with patients in control group (P<0.05). Patients with STEMI had no significant difference in all 3 myocardial layers assessed by GLS, DGLS and infarcted segments TLS, DTLS compared with patients in NSTEMI group. ③ Patients with NSTEMI and STEMI had low value in all 3 myocardial layers assessed by GCS, DGCS and infarcted segments TCS, DTCS compared with patients in control group (P<0.05). Patients with STEMI had no significant difference in all 3 myocardial layers assessed by GCS, DGCS and infarcted segments TCS, DTCS compared with patients in NSTEMI group, except for GCS of epicardium, which is lower than the value of NSTEMI group (P<0.05).
CONCLUSIONS Baseline STI metrics precisely predicted LVR at 6-month follow-up. Among the STI metrics, CS_WMSI has shown preferable predictive and diagnostic value, which indicates the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction.
CONCLUSIONS Longitudinal and circumferential strain by 2D-STE for the layer-specific quantitative analyses have provided useful information for clinical diagnosis of NSTEMI.
GW27-e0207 Positive and negative prediction of heart failure and left ventricular remodeling by speckle tracking imaging: a clinical follow-up study of acute myocardial infarction
GW27-e0214 Evaluation of the short time prognosis of the right ventricular systolic function after percutaneous coronary intervention in patients with inferior wall myocardial infarction
Hu Bo, Ruiqiang Guo renmin hospital of wuhan university
Yao Xue, Ruiqiang Guo renmin hospital of wuhan university
OBJECTIVES We sought to study the progress of heart failure (HF) and left ventricular remodeling (LVR) of the first onset myocardial infarction. Positive and negative values of prediction were analyzed for the patients as well as the change of myocardial systolic function after the infarction.
OBJECTIVES The aim of the study is to assess the short time recovery of the right ventricular systolic function in inferior wall infarction patients with or without right ventricular (RV) myocardial infarction after percutaneous coronary intervention (PCI) by using 2-dimensional (2D) speckle tracking imaging (STI) longitudinal strain (LS) parameters.
METHODS 78 patients with first onset ST segment elevated acute myocardial infarction were enrolled. Echocardiography were performed within 24 hours of the onset, 3-month and 6-month after the infarction. At the points of follow-ups, HF was defined as LVEF failed to increase more than 5% and was lower than 35% and LVR was defined as left ventricular end-diastolic volume increased more than 20%. We compared the changes of two-dimensional and speckle tracking metrics and their relations at different time points for the predictive values of HF and LVR.
METHODS 38 consecutive patients diagnosed with inferior wall myocardial infarction (IWMI) and treated with percutaneous coronary intervention were included in our study. 17 of them were combined with right ventricular myocardial infarction (RVMI). 24 chest pain patients admitted at the same time but with negative results in the selective coronary angiography were served as blank control. Echocardiography were performed at baseline and for 15 patients before discharged from the hospital (5.22.3 days). Right ventricular 2D strain parameters were then analyzed off line.
RESULTS Both two-dimensional and speckle tracking metrics at 6-month follow-up were better than the baseline (P＜0.05, all). Minimal data point of longitudinal strain was the most powerful predicted factor for HF (AUC: 0.792 with sensitivity of 82% and specificity of 86%) while minimal circumferential strain was the best for the prediction of LVR (AUC: 0.821 with sensitivity of 85% and specificity of 83%). As the negative values, we found that changes of longitudinal strain from baseline to 3-month (AUC: 0.754 with sensitivity of 78% and specificity of 75%) best predicted not to be HF as the change of circumferential strain (AUC: 0.776 with sensitivity of 84% and specificity of 81%) for LVR.
RESULTS The RV global LS (RVGLS), the LS of the basal and mid segments of the free wall and septum were lower than control group in the patient group (P<0.05). Compared with INFMI group, the RVGLS, the LS of the mid and apical segments of the free wall were lower in the RVMI group (P<0.05). Few days after PCI, basement and middle segments of the free wall (P<0.01) were higher with smaller right ventricular end diastolic (P<0.01) and systolic (P<0.05) area. Tricuspid annular plane systolic excursion were also higher than before (P<0.05).
CORONARY INTERVENTION GW27-e0101 Impact of thrombus aspiration versus direct stenting on outcome of patients with primary percutaneous coronary intervention Rama Kumari,1 Radhika S,1 Aruna devi M,1 Bhaskaraju,2 Sai Satish,1 LSR Krishna1 1 Nizam’s institute of medical sciences; 2Gandhi medical college OBJECTIVES Aim of the study is to describe the impact of routine aspiration thrombectomy with PCI versus PCI alone in patients with STEMI. To study the post procedural outcomes post PCI TIMI flow and long term mortality. METHODS Study population: patients with symptom onset < 12 hours and atleast 1mm ST elevation in 2 > contiguous limb leads or atleast 2 mm ST elevation in 2> contiguous precordial leads or LBBB are considered for PPCI. They are divided into 2 groups, PCI alone and PCI with thrombectomy group. Study outcomes: The primary efficacy outcome was death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA class IV heart failure within 180 days. Key secondary outcome was cardiovascular deaths, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA class IV heart failure, stent thrombosis or target-vessel revascularization within 180 days. Statistical analysis: Primary and secondary outcomes are analyzed by cox regression analysis and hazard ratios for the events were compared between two groups. Kaplan meier estimates for the primary outcome was done in PCI alone and thrombectomy group within 180 days after the procedure. RESULTS In this study, 84 patients were included of whom 53 underwent PCI alone and 31 underwent thrombus aspiration plus PCI. The mean age was 57.3 10 and 55.8 11.2 in PCI alone and thrombectomy group respectively.The rate of the primary outcome in patients who underwent PCI for index STEMI was 18.8% in the PCI-alone group was 9.67% in the thrombectomy group (hazard ratio for the thrombectomy group as compared with PCI alone group was 1.94; 95% confidence interval [CI], 0.46 to 8.03; P ¼ 0.36). The secondary outcome occurred in 33.96% of patients in PCI alone group and 25.8% of patients in thrombectomy group (hazard ratio 1.33; 95% CI 0.573.05 with p value of 0.5). Subgroup analysis of the study done for the occurrence of the primary outcome within 180 days, revealed that the patients with initial TIMI thrombus grade 3, anterior wall MI and symptom onset < 6hrs had a higher risk of mortality in PCI alone group when compared to thrombectomy group however it was not statistically significant. (HR 2.00; 95% CI 0.4-10; p¼0.41, HR 2.5; 95% CI 0.5-11.7; p¼0.25, HR 3.76; 95%CI 0.4-33.7; p¼0.24 respectively). In our study, two patients suffered from stroke, one in each group. Kaplan meier analysis demonstrated that there was no statistically significant difference in time to death between the 2 groups over a period of 180 days. CONCLUSIONS In our study, patients who were undergoing primary PCI, there was 94% higher risk of death within 180 days in PCI alone group when compared to thrombectomy group. In patients with higher initial TIMI thrombus grade or anterior wall MI or symptom onset less than 6 hrs had higher risk of death with PCI alone as compared with thrombectomy. Our study demonstrates that thrombus aspiration followed by PCI yields better clinical outcomes in such cases.
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into 3 groups according to their C-ACS scores: Group 1, score 0; Group 2, score 1; and Group 3, score 2. The primary outcomes were the development of CIN and major clinical adverse events (MACEs). RESULTS Overall, 33 patients (8.4%) developed CIN. Patients with high C-ACS risk scores were more likely to develop CIN (2.8%, 10.3%, 26.4% for C-ACS score 0; 1; 2, respectively, p< 0.001), as well with the in-hospital death and MACEs. After adjusting for potential confounding predictors, C-ACS risk scores remained significantly associated with CIN (OR¼2.87, 95%CI, 1.78-4.63, p < 0.001). ROC showed that C-ACS risk scores has good predictive values for CIN, in-hospital morality, MACEs and long-term mortality (C statistic¼0.751, 0.712, 0.628, respectively). In addition, patients with high C-ACS risk scores exhibited a worse survival rate than patients with low risk scores (Death, p¼0.02; MACEs, p¼0.006). Furthermore, the C-ACS risk score was independently associated with the long-term MACEs (hazard ratio ¼1.30, 95% CI¼1.04-1.64, p¼0.022). CONCLUSIONS C-ACS risk score can be simply used to predict CIN and to stratify patients for poor clinical outcomes both in the shortand long-term follow-up in patients with STEMI before primary PCI. GW27-e0184 9 months clinic results of drug-coating balloons (DCB) in single center real-work of China Zhang Wenduo, Yu Xue, Wang Xinyue, Fukui Ji Beijing Hospital OBJECTIVES Drug coating balloon (DCB) is a new therapeutic option for treatment of obstructive coronary lesions in percutaneous coronary intervention (PCI). There is limited data on the safety and efficacy of DCB in China patients in contemporary clinical registries. We aim to evaluated the clinical efficacy and safety of SeQuent Please paclitaxel-coating balloon in our single center patients in real world clinical practice. METHODS Between August 2014 to March 2015, 80 patients (51% male, mean age 66 10 years) with a total of 85 coronary lesions were treated with SeQuent Please DCB. The primary endpoint was major adverse cardiac events (MACE) composite of cardiovascular death, target vessel related myocardial infarction (MI) and target lesion revascularization (TLR) at 9 months follow-up. RESULTS The majority of patients presented with acute coronary syndrome (76%). An average DCB diameter was 2.70.45 mm and average total length was 15.83.9 mm. At 9 months’ follow-up, 3.75% of patients developed MACE. MACE was mainly driven by TLR(1.25%) followed by target vessel related myocardial infarction (1.25%) and cardiovascular death (2.5%). CONCLUSIONS SeQuent Please DCB was a safe and effective treatment modality in our single center Chinese patients with a low incidence of MACE observed at 9 months follow-up. GW27-e0200 Serial assessment of calcification 5 years after bioresorbable vascular scaffold implantation: fusion of intravascular ultrasound and optical coherence tomography Zeng Yaping,1 Patrick W. Serruys2 1 The Emergency & Critical Care Center of Beijing Anzhen Hospital, Capital Medical University, Beijing, the People’s Republic of China; 2 International Centre for Circulatory Health, Imperial College, London, United Kingdom
GW27-e0160 A new simple pre-procedure risk score for early predicting contrastinduced nephropathy and long-term outcomes in patients undergoing primary percutaneous coronary intervention
OBJECTIVES To assess calcium growth with fused greyscale-IVUS, virtual histology-IVUS (VH-IVUS) and OCT from baseline to 5-year follow-up in patients treated with Bioresorbable Vascular Scaffolds (BVS).
Liu Yuanhui, Yong Liu, Ji-yan Chen, Ning Tan Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Ac
METHODS Anatomic landmarks and endoluminal radiopaque markers were used to fuse OCT and IVUS images and match baseline and follow-up.
OBJECTIVES Contrast-induced nephropathy (CIN) is a common complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may cause increased morbidity and mortality. We aimed to evaluate the predictive value of Canada Acute Coronary Syndrome (C-ACS) risk score for CIN in STEMI patients before primary PCI, allowing pre-procedural decisions regarding prevention therapy for CIN. METHODS A total of 394 consecutive patients with STEMI undergoing primary PCI enrolled in this study. The study patients were divided
RESULTS Seventy-two VH-IVUS and OCT paired matched crosssection in- and out-scaffold segments were fused at baseline and follow-up. In total, 46 calcified plaques at follow-up were detected by the fusion method (33 in-,13 out-scaffold), showing either calcium progression (52.2%) or de novo calcifications(47.8%). On OCT, calcification volume increased from baseline to follow-up by 2.32.4mm3 (p¼0.001). The baseline VH tissue precursors of dense calcium(DC) at follow-up were necrotic core(NC)in 73.9% and Fibrous/ Fibrofatty (F/FF) in 10.9%. In 15.2%, calcium was already present at baseline. Precursors on OCT were lipid pool in 71.2%, fibrous in 4.3%, and fibrocalcific plaque in 23.9%.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
CONCLUSIONS The use of OCT/IVUS fusion imaging shows similar calcium growth in-and out-scaffold segments. NC is the most frequent precursor of calcification. The scaffold resorption process creates a tissuelayer that recaps the calcified plaques. GW27-e0206 Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index: a clinical follow-up study Hu Bo, Ruiqiang Guo renmin hospital of wuhan university OBJECTIVES Segmental wall motion dysfunction after acute myocardial infarction (AMI) has led to progressing left ventricular remodeling (LVR), which has gradually worsened cardiac function of AMI patients with poor prognosis. Our study sought to explore the prognostic value of speckle tracking imaging (STI) for LVR in AMI patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI). METHODS 83 patients with first onset AMI were enrolled from Jan 2012 to May 2015 and underwent echocardiography within 24hs of the infarcted onset (baseline) and at 6-month follow-up. LVR was defined as the percentage change of left ventricular end-diastolic volume (DLVEDV%) from baseline to 6-month follow-up was more than 20% (divided as LVR and non-LVR group). Standard long-axis and shortaxis views were stored and analyzed for longitudinal (LS), radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI. Segments of WMSI2 were selected and calculated for the mean values of LS (LS_WMSI), RS (RS_WMSI) and CS (CS_WMSI). RESULTS LVR occurred in 27 AMI patients at 6-month follow-up. No difference has shown for demographics, electrocardiogram, lab tests, coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline, while all STI metrics were found statistical difference for the comparisons (P＜0.05, all), especially the WMSI selected STI metrics (P＜0.001, all). Linear regression analysis demonstrated that CS_WMSI (r¼0.716，P＜0.001) was the best correlated to DLVEDV% among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6%, specificity of 87.5% and area under the curve of 0.9563).
CONCLUSIONS Speckle tracking echocardiography has the strong power for positive and negative prediction of HF and LVR after myocardial infarction. Metrics of longitudinal strain as minimum segmental strain and change rate of strain were optimal for the prediction of HF as well as the corresponding metrics of circumferential strain for the prediction of LVR. GW27-e0213 Assessment of the left ventricular layer-specific strain in patients with Non-ST Segment elevation acute myocardial infarction by 2-dimensional speckle-tracking echocardiography Zhu Jingjing, Ruiqiang Guo renmin hospital of wuhan university OBJECTIVES We sought to discuss the clinical value of 2D-STE for the identification of NSTEMI by assessing left ventricular layer-specific strain in patients with NSTEMI. METHODS Sixty patients due to suspected AMI, divided into two groups based on electrocardiogram (ECG), NSTEMI group containing 30 patients, STEMI group containing 30 patients, and thirty age and gender matched subjects were involved as the control group. Layer-specific global longitudinal and circumferential strains (GLS and GCS) were assessed at endocardium, midmyocardium and epicardium by 2D-STE, so were territorial longitudinal and circumferential strains(TLS and TCS). The absolute differences between endocardial and epicardial GLS, GCS, infarcted segments TLS, TCS (DGLS, DGCS, DTLS, DTCS) were calculated . RESULTS ① Left ventricular segments of patients from NSTEMI group and STEMI group were divided into normal segments and Infarcted segments based on the selective coronary arteriography(SCA). ②Patients with NSTEMI and STEMI had low value in all 3 myocardial layers assessed by GLS, DGLS and infarcted segments TLS, DTLS compared with patients in control group (P<0.05). Patients with STEMI had no significant difference in all 3 myocardial layers assessed by GLS, DGLS and infarcted segments TLS, DTLS compared with patients in NSTEMI group. ③ Patients with NSTEMI and STEMI had low value in all 3 myocardial layers assessed by GCS, DGCS and infarcted segments TCS, DTCS compared with patients in control group (P<0.05). Patients with STEMI had no significant difference in all 3 myocardial layers assessed by GCS, DGCS and infarcted segments TCS, DTCS compared with patients in NSTEMI group, except for GCS of epicardium, which is lower than the value of NSTEMI group (P<0.05).
CONCLUSIONS Baseline STI metrics precisely predicted LVR at 6-month follow-up. Among the STI metrics, CS_WMSI has shown preferable predictive and diagnostic value, which indicates the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction.
CONCLUSIONS Longitudinal and circumferential strain by 2D-STE for the layer-specific quantitative analyses have provided useful information for clinical diagnosis of NSTEMI.
GW27-e0207 Positive and negative prediction of heart failure and left ventricular remodeling by speckle tracking imaging: a clinical follow-up study of acute myocardial infarction
GW27-e0214 Evaluation of the short time prognosis of the right ventricular systolic function after percutaneous coronary intervention in patients with inferior wall myocardial infarction
Hu Bo, Ruiqiang Guo renmin hospital of wuhan university
Yao Xue, Ruiqiang Guo renmin hospital of wuhan university
OBJECTIVES We sought to study the progress of heart failure (HF) and left ventricular remodeling (LVR) of the first onset myocardial infarction. Positive and negative values of prediction were analyzed for the patients as well as the change of myocardial systolic function after the infarction.
OBJECTIVES The aim of the study is to assess the short time recovery of the right ventricular systolic function in inferior wall infarction patients with or without right ventricular (RV) myocardial infarction after percutaneous coronary intervention (PCI) by using 2-dimensional (2D) speckle tracking imaging (STI) longitudinal strain (LS) parameters.
METHODS 78 patients with first onset ST segment elevated acute myocardial infarction were enrolled. Echocardiography were performed within 24 hours of the onset, 3-month and 6-month after the infarction. At the points of follow-ups, HF was defined as LVEF failed to increase more than 5% and was lower than 35% and LVR was defined as left ventricular end-diastolic volume increased more than 20%. We compared the changes of two-dimensional and speckle tracking metrics and their relations at different time points for the predictive values of HF and LVR.
METHODS 38 consecutive patients diagnosed with inferior wall myocardial infarction (IWMI) and treated with percutaneous coronary intervention were included in our study. 17 of them were combined with right ventricular myocardial infarction (RVMI). 24 chest pain patients admitted at the same time but with negative results in the selective coronary angiography were served as blank control. Echocardiography were performed at baseline and for 15 patients before discharged from the hospital (5.22.3 days). Right ventricular 2D strain parameters were then analyzed off line.
RESULTS Both two-dimensional and speckle tracking metrics at 6-month follow-up were better than the baseline (P＜0.05, all). Minimal data point of longitudinal strain was the most powerful predicted factor for HF (AUC: 0.792 with sensitivity of 82% and specificity of 86%) while minimal circumferential strain was the best for the prediction of LVR (AUC: 0.821 with sensitivity of 85% and specificity of 83%). As the negative values, we found that changes of longitudinal strain from baseline to 3-month (AUC: 0.754 with sensitivity of 78% and specificity of 75%) best predicted not to be HF as the change of circumferential strain (AUC: 0.776 with sensitivity of 84% and specificity of 81%) for LVR.
RESULTS The RV global LS (RVGLS), the LS of the basal and mid segments of the free wall and septum were lower than control group in the patient group (P<0.05). Compared with INFMI group, the RVGLS, the LS of the mid and apical segments of the free wall were lower in the RVMI group (P<0.05). Few days after PCI, basement and middle segments of the free wall (P<0.01) were higher with smaller right ventricular end diastolic (P<0.01) and systolic (P<0.05) area. Tricuspid annular plane systolic excursion were also higher than before (P<0.05).