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

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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.

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Data availability

The data used in this study is based on human patients and is therefore governed by the Danish Data Protection Agency. In order to gain access to the data, any additional researcher is required to file a formal application to the Danish Data Protection Agency. Therefore, the authors cannot grant access to the data used in this study unless anyone interested is approved by the Danish Data Protection Agency.

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Authors and Affiliations

  1. Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark

    Inge Noringriis, Daniel Modin, Sune H. Pedersen, Jan S. Jensen & Tor Biering-Sørensen

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  1. Inge Noringriis
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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.

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

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Noringriis, I., Modin, D., Pedersen, S.H. et al. Prognostic importance of mechanical dyssynchrony in predicting heart failure development after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 35, 87–97 (2019). https://doi.org/10.1007/s10554-018-1443-9

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  • DOI: https://doi.org/10.1007/s10554-018-1443-9

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