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PREVALENCE OF DYSSYNCHRONY AND RELATION WITH LONG-TERM OUTCOME IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION
E804 JACC April 5, 2011 Volume 57, Issue 14
IMAGING AND DIAGNOSTIC TESTING PREVALENCE OF DYSSYNCHRONY AND RELATION WITH LONG-TERM OUTCOME IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Echocardiographic Insights To Disease Mechanisms Abstract Category: 31. General Echocardiography: TTE Session-Poster Board Number: 1126-192 Authors: Maria Louisa Antoni, Victoria Delgado, Jael Z. Atary, Eduard R. Holman, Martin J. Schalij, Jeroen J. Bax, Leiden University Medical Center, Leiden, The Netherlands Background: Recently, several studies have demonstrated the predictive value of left ventricular (LV) dyssynchrony for the development of LV remodeling in patients with acute myocardial infarction (AMI). However, data about the relation between LV dyssynchrony and prognosis in this population are scarce. The purpose of the present study was to evaluate the prevalence of LV dyssynchrony after AMI using speckle-tracking imaging and to assess the relation between LV dyssynchrony and adverse outcome. Methods: Consecutive patients admitted with AMI treated with primary percutaneous coronary intervention (PCI) were evaluated. All patients were treated according to the institutional AMI protocol, which includes 2D echocardiography within 48 hours of admission and follow-up at the outpatient clinic. To obtain LV dyssynchrony, peak systolic radial strain was assessed on the LV short-axis images at the level of the papillary muscle segments and LV dyssynchrony was calculated as the time difference between the earliest and latest activated segments. Results: A total of 905 patients (mean age: 60±12 years, 79% men) were followed for 20 months. During follow-up 69 patients(8%) reached the primary endpoint of all-cause mortality. Mean LV dyssynchrony was 65±80 ms and 126 patients (14%) demonstrated ≥130ms time difference between the earliest and latest activated segments defined as LV dyssynchrony. At 3 years follow-up, significantly more patients with LV dyssynchrony died (34%vs.7%, p<0.001). After adjustment for a broad range of clinical and echocardiographic parameters, LV dyssynchrony (HR 1.05, 95%CI 1.03-1.08, p<0.001 per 10ms increase) was significantly associated with all-cause mortality after AMI in addition to known predictors including age (1.06, 95%1.03-1.10, p<0.001) and LV ejection fraction (HR 0.95, 95%CI 0.91-0.99, p=0.02). Of note, patients with LV dyssynchrony demonstrated a 5 times increased risk of all-cause mortality (HR 4.54, 95%CI 2.70-7.64, p<0.001) compared to patients without LV dyssynchrony. Conclusions: LV dyssynchrony is an important risk factor for all-cause mortality in patients with AMI treated with primary PCI.
IMAGING AND DIAGNOSTIC TESTING PREVALENCE OF DYSSYNCHRONY AND RELATION WITH LONG-TERM OUTCOME IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Echocardiographic Insights To Disease Mechanisms Abstract Category: 31. General Echocardiography: TTE Session-Poster Board Number: 1126-192 Authors: Maria Louisa Antoni, Victoria Delgado, Jael Z. Atary, Eduard R. Holman, Martin J. Schalij, Jeroen J. Bax, Leiden University Medical Center, Leiden, The Netherlands Background: Recently, several studies have demonstrated the predictive value of left ventricular (LV) dyssynchrony for the development of LV remodeling in patients with acute myocardial infarction (AMI). However, data about the relation between LV dyssynchrony and prognosis in this population are scarce. The purpose of the present study was to evaluate the prevalence of LV dyssynchrony after AMI using speckle-tracking imaging and to assess the relation between LV dyssynchrony and adverse outcome. Methods: Consecutive patients admitted with AMI treated with primary percutaneous coronary intervention (PCI) were evaluated. All patients were treated according to the institutional AMI protocol, which includes 2D echocardiography within 48 hours of admission and follow-up at the outpatient clinic. To obtain LV dyssynchrony, peak systolic radial strain was assessed on the LV short-axis images at the level of the papillary muscle segments and LV dyssynchrony was calculated as the time difference between the earliest and latest activated segments. Results: A total of 905 patients (mean age: 60±12 years, 79% men) were followed for 20 months. During follow-up 69 patients(8%) reached the primary endpoint of all-cause mortality. Mean LV dyssynchrony was 65±80 ms and 126 patients (14%) demonstrated ≥130ms time difference between the earliest and latest activated segments defined as LV dyssynchrony. At 3 years follow-up, significantly more patients with LV dyssynchrony died (34%vs.7%, p<0.001). After adjustment for a broad range of clinical and echocardiographic parameters, LV dyssynchrony (HR 1.05, 95%CI 1.03-1.08, p<0.001 per 10ms increase) was significantly associated with all-cause mortality after AMI in addition to known predictors including age (1.06, 95%1.03-1.10, p<0.001) and LV ejection fraction (HR 0.95, 95%CI 0.91-0.99, p=0.02). Of note, patients with LV dyssynchrony demonstrated a 5 times increased risk of all-cause mortality (HR 4.54, 95%CI 2.70-7.64, p<0.001) compared to patients without LV dyssynchrony. Conclusions: LV dyssynchrony is an important risk factor for all-cause mortality in patients with AMI treated with primary PCI.