Advertisement

Prognostic importance of mechanical dyssynchrony in predicting heart failure development after ST-segment elevation myocardial infarction

  • Inge Noringriis
  • Daniel Modin
  • Sune H. Pedersen
  • Jan S. Jensen
  • Tor Biering-Sørensen
Original Paper
  • 45 Downloads

Abstract

The aim of this study is to assess the prognostic value of mechanical dyssynchrony defined as the standard deviation of the time to peak longitudinal strain (SD T2P LS) in predicting the development of heart failure (HF) after an ST-segment elevation myocardial infarction (STEMI). Three hundred and seventy-three patients were admitted with STEMI and treated with primary percutaneous coronary intervention. Left ventricular (LV) mechanical dyssynchrony was examined through speckle tracking echocardiography and defined as SD T2P LS. The association with the outcome of HF hospitalization was assessed using Cox proportional hazard models. During a median follow-up of 5.12 years, 144 patients (38.6%) were admitted due to HF. Worse dyssynchrony was associated with the outcome in unadjusted and multivariable analysis (multivariable hazard ratio 1.05, 95% confidence interval 1.00–1.10, p-value 0.039, per 10 ms increase), but not after further adjustment for LV ejection fraction (LVEF), E/e′ and global longitudinal strain (GLS) (hazard ratio 1.01, 95% confidence interval 1.00–1.07, p-value 0.71, per 10 ms increase), nor in a model only adjusting for GLS (hazard ratio 1.01, 95% confidence interval 1.00–1.06, p-value 0.61, per 10 ms increase). These findings were reproduced in a competing risk analysis treating all-cause mortality as a competing risk. LV mechanical dyssynchrony, as assessed by SD T2P LS is not an independent predictor of post-STEMI HF development and mechanical dyssynchrony does not provide independent prognostic information regarding HF when GLS is known.

Keywords

Dyssynchrony Speckle tracking ST elevation myocardial infarction Heart failure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10554_2018_1443_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 KB)

References

  1. 1.
    Voigt J-U, Pedrizzetti G, Lysyansky P et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr 28:183–193.  https://doi.org/10.1016/j.echo.2014.11.003 CrossRefGoogle Scholar
  2. 2.
    Mądry W, Karolczak MA (2016) Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part II. J Ultrason 16:304–316.  https://doi.org/10.15557/JoU.2016.0031 CrossRefGoogle Scholar
  3. 3.
    Voigt J-U, Lindenmeier G, Exner B et al (2003) Incidence and characteristics of segmental postsystolic longitudinal shortening in normal, acutely ischemic, and scarred myocardium. J Am Soc Echocardiogr 16:415–423CrossRefGoogle Scholar
  4. 4.
    Asanuma T, Nakatani S (2015) Myocardial ischaemia and post-systolic shortening. Heart (Br Card Soc) 101:509–516.  https://doi.org/10.1136/heartjnl-2013-305403 Google Scholar
  5. 5.
    Bijnens B, Claus P, Weidemann F et al (2007) Investigating cardiac function using motion and deformation analysis in the setting of coronary artery disease. Circulation 116:2453–2464.  https://doi.org/10.1161/CIRCULATIONAHA.106.684357 CrossRefGoogle Scholar
  6. 6.
    Meimoun P, Abouth S, Clerc J et al (2015) Usefulness of two-dimensional longitudinal strain pattern to predict left ventricular recovery and in-hospital complications after acute anterior myocardial infarction treated successfully by primary angioplasty. J Am Soc Echocardiogr 28:1366–1375.  https://doi.org/10.1016/j.echo.2015.07.022 CrossRefGoogle Scholar
  7. 7.
    Nucifora G, Bertini M, Marsan NA et al (2010) Impact of left ventricular dyssynchrony early on left ventricular function after first acute myocardial infarction. Am J Cardiol 105:306–311.  https://doi.org/10.1016/j.amjcard.2009.09.028 CrossRefGoogle Scholar
  8. 8.
    Gorcsan J, Tanaka H (2011) Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 58:1401–1413.  https://doi.org/10.1016/j.jacc.2011.06.038 CrossRefGoogle Scholar
  9. 9.
    Gorcsan J, Sogaard P, Bax JJ et al (2016) Association of persistent or worsened echocardiographic dyssynchrony with unfavourable clinical outcomes in heart failure patients with narrow QRS width: a subgroup analysis of the EchoCRT trial. Eur Heart J 37:49–59.  https://doi.org/10.1093/eurheartj/ehv418 CrossRefGoogle Scholar
  10. 10.
    Biering-Sørensen T, Shah SJ, Anand I et al (2017) Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail.  https://doi.org/10.1002/ejhf.789 Google Scholar
  11. 11.
    Stankovic I, Putnikovic B, Janicijevic A et al (2015) Myocardial mechanical and QTc dispersion for the detection of significant coronary artery disease. Eur Heart J Cardiovasc Imaging 16:1015–1022.  https://doi.org/10.1093/ehjci/jev029 CrossRefGoogle Scholar
  12. 12.
    Leong DP, Hoogslag GE, Piers SRD et al (2015) The relationship between time from myocardial infarction, left ventricular dyssynchrony, and the risk for ventricular arrhythmia: speckle-tracking echocardiographic analysis. J Am Soc Echocardiogr 28:470–477.  https://doi.org/10.1016/j.echo.2014.12.012 CrossRefGoogle Scholar
  13. 13.
    Haugaa KH, Grenne BL, Eek CH et al (2013) Strain echocardiography improves risk prediction of ventricular arrhythmias after myocardial infarction. JACC Cardiovasc Imaging 6:841–850.  https://doi.org/10.1016/j.jcmg.2013.03.005 CrossRefGoogle Scholar
  14. 14.
    Shin S-H, Hung C-L, Uno H et al (2010) Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation 121:1096–1103.  https://doi.org/10.1161/CIRCULATIONAHA.109.863795 CrossRefGoogle Scholar
  15. 15.
    Antoni ML, Boden H, Hoogslag GE et al (2011) Prevalence of dyssynchrony and relation with long-term outcome in patients after acute myocardial infarction. Am J Cardiol 108:1689–1696.  https://doi.org/10.1016/j.amjcard.2011.07.037 CrossRefGoogle Scholar
  16. 16.
    Westholm C, Johnson J, Jernberg T, Winter R (2013) The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome. Cardiovasc Ultrasound 11:35.  https://doi.org/10.1186/1476-7120-11-35 CrossRefGoogle Scholar
  17. 17.
    Cong T, Sun Y, Shang Z et al (2015) Prognostic value of speckle tracking echocardiography in patients with ST-elevation myocardial infarction treated with late percutaneous intervention. Echocardiogr Mt Kisco N 32:1384–1391.  https://doi.org/10.1111/echo.12864 CrossRefGoogle Scholar
  18. 18.
    Shah AM, Solomon SD (2012) Myocardial deformation imaging: current status and future directions. Circulation 125:e244–e248.  https://doi.org/10.1161/CIRCULATIONAHA.111.086348 CrossRefGoogle Scholar
  19. 19.
    Fontana A, Zambon A, Cesana F et al (2012) Tissue Doppler, triplane echocardiography, and speckle tracking echocardiography: different ways of measuring longitudinal myocardial velocity and deformation parameters. A comparative clinical study. Echocardiogr Mt Kisco N 29:428–437.  https://doi.org/10.1111/j.1540-8175.2011.01618.x CrossRefGoogle Scholar
  20. 20.
    Ng ACT, Tran DT, Newman M et al (2008) Comparison of left ventricular dyssynchrony by two-dimensional speckle tracking versus tissue Doppler imaging in patients with non-ST-elevation myocardial infarction and preserved left ventricular systolic function. Am J Cardiol 102:1146–1150.  https://doi.org/10.1016/j.amjcard.2008.06.033 CrossRefGoogle Scholar
  21. 21.
    Olsen FJ, Pedersen S, Jensen JS, Biering-Sørensen T (2016) Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction. Medicine (Baltimore) 95:e5338.  https://doi.org/10.1097/MD.0000000000005338 CrossRefGoogle Scholar
  22. 22.
    Biering-Sørensen T, Jensen JS, Pedersen SH et al (2016) Regional longitudinal myocardial deformation provides incremental prognostic information in patients with ST-segment elevation myocardial infarction. PLoS ONE 11:e0158280.  https://doi.org/10.1371/journal.pone.0158280 CrossRefGoogle Scholar
  23. 23.
    Biering-Sørensen T, Jensen JS, Pedersen S et al (2014) Doppler tissue imaging is an independent predictor of outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Soc Echocardiogr 27:258–267.  https://doi.org/10.1016/j.echo.2013.11.005 CrossRefGoogle Scholar
  24. 24.
    Biering-Sørensen T, Mogelvang R, Søgaard P et al (2013) Prognostic value of cardiac time intervals by tissue Doppler imaging M-mode in patients with acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging 6:457–465.  https://doi.org/10.1161/CIRCIMAGING.112.000230 CrossRefGoogle Scholar
  25. 25.
    Kümler T, Gislason GH, Kirk V et al (2008) Accuracy of a heart failure diagnosis in administrative registers. Eur J Heart Fail 10:658–660.  https://doi.org/10.1016/j.ejheart.2008.05.006 CrossRefGoogle Scholar
  26. 26.
    Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270.  https://doi.org/10.1093/ehjci/jev014 CrossRefGoogle Scholar
  27. 27.
    Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360.  https://doi.org/10.1093/ehjci/jew082 CrossRefGoogle Scholar
  28. 28.
    Stone GW, Selker HP, Thiele H et al (2016) Relationship between infarct size and outcomes following primary PCI: patient-level analysis from 10 randomized trials. J Am Coll Cardiol 67:1674–1683.  https://doi.org/10.1016/j.jacc.2016.01.069 CrossRefGoogle Scholar
  29. 29.
    Hillis GS, Møller JE, Pellikka PA et al (2004) Noninvasive estimation of left ventricular filling pressure by E/e’ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 43:360–367.  https://doi.org/10.1016/j.jacc.2003.07.044 CrossRefGoogle Scholar
  30. 30.
    Munk K, Andersen NH, Terkelsen CJ et al (2012) Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr 25:644–651.  https://doi.org/10.1016/j.echo.2012.02.003 CrossRefGoogle Scholar
  31. 31.
    Antoni ML, Mollema SA, Delgado V et al (2010) Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J 31:1640–1647.  https://doi.org/10.1093/eurheartj/ehq105 CrossRefGoogle Scholar
  32. 32.
    Bochenek T, Wita K, Tabor Z et al (2011) Value of speckle-tracking echocardiography for prediction of left ventricular remodeling in patients with ST-elevation myocardial infarction treated by primary percutaneous intervention. J Am Soc Echocardiogr 24:1342–1348.  https://doi.org/10.1016/j.echo.2011.09.003 CrossRefGoogle Scholar
  33. 33.
    Bière L, Donal E, Terrien G et al (2014) Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment elevation myocardial infarction. PLoS ONE 9:e86959.  https://doi.org/10.1371/journal.pone.0086959 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Cardiology, Herlev & Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations