Abstract | BACKGROUND:
Heart failure (HF) complicating acute myocardial infarction (MI) is an ominous prognostic sign frequently caused by left ventricular ( LV) systolic dysfunction. However, many patients develop HF despite preserved LV ejection fractions. The aim of this study was to test the hypothesis that LV longitudinal function is a stronger marker of in-hospital HF than traditional echocardiographic indices. METHODS: A total of 548 patients with acute MIs were evaluated (mean age, 63.2 ± 11.7 years; 71.6% men). Within 48 hours of admission, comprehensive echocardiography with assessment of global longitudinal strain (GLS) was performed, along with measurements of N-terminal pro- brain natriuretic peptide. RESULTS: A total 89 patients (16.2%) had in-hospital HF assessed by Killip class > 1 in whom GLS was significantly impaired compared with patients without in-hospital HF (Killip class 1) (-14.6 ± 3.3% vs -10.1 ± 3.5%, P < .0001). In stepwise multiple logistic regression analysis including age, known HF, three-vessel disease, involvement of the left anterior descending coronary artery, episodes of atrial fibrillation, renal function, N-terminal pro- brain natriuretic peptide, troponin T level, LV ejection fraction, wall motion score index, and diastolic dysfunction indices, GLS emerged as the strongest marker of clinical HF (odds ratio, 1.47; 95% confidence interval [CI], 1.33-1.62; P < .0001). GLS remained independently associated with in-hospital HF in patients with LV ejection fractions > 40% (odds ratio, 1.33; 95% CI, 1.14-1.54; P < .05) and improved the C-statistic over other important covariates significantly (0.87 [95% CI, 0.82-0.91] vs 0.82 [95% CI, 0.76-0.89], P = .02). CONCLUSIONS: Global longitudinal function assessed by GLS is significantly impaired in patients with MIs with in-hospital HF, and multivariate analysis suggests that reduced GLS is the single most powerful marker of manifest LV hemodynamic deterioration in the acute phase of MI.
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Authors | Mads Ersbøll, Nana Valeur, Ulrik Madvig Mogensen, Mads J Andersen, Jacob Eifer Møller, Christian Hassager, Peter Søgaard, Lars Køber |
Journal | Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
(J Am Soc Echocardiogr)
Vol. 25
Issue 12
Pg. 1280-9
(Dec 2012)
ISSN: 1097-6795 [Electronic] United States |
PMID | 23072712
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved. |
Topics |
- Comorbidity
- Denmark
(epidemiology)
- Echocardiography
(statistics & numerical data)
- Elasticity Imaging Techniques
(statistics & numerical data)
- Female
- Heart Failure
(diagnostic imaging, epidemiology)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(diagnostic imaging, epidemiology)
- Prevalence
- Risk Factors
- Statistics as Topic
- Ventricular Dysfunction, Left
(diagnostic imaging, epidemiology)
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