Page 132 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou
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Chapter seven. LVMD in STEMI and prognosis
Cardiovascular medications at hospital discharge were optimized and titrated at the discretion of the treating physician. During invasive coronary angiography, the culprit vessel was identified and multi-vessel disease was defined as the presence of more than one vessel with luminal narrowing ≥70%. All clinical data were prospectively collected in the Cardiology Department Information System (EZIS chipsoft & EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands).
Transthoracic echocardiography
Two-dimensional transthoracic echocardiography was performed using commercially available ultrasound systems (Vivid 7, E9 and E95; General Electric Vingmed, Milwaukee, Wisconsin) with the patients at rest in the left lateral decubitus position. Data acquisition was performed with 3.5-MHz or M5S transducers. Standard M-mode, 2D, color, pulsed and continuous wave Doppler images were acquired and stored digitally for offline analysis (EchoPac BT13; GE Medical Systems, Horten, Norway). The LVEF was calculated using the Simpson’s biplane method of discs on the apical 2- and 4-chamber views.13 The wall motion score index (WMSI) was defined as the total sum of the segmental scores divided by the number of segments scored.13 LV mass was calculated as previously described and indexed for body surface area.13 In addition, LV diastolic function was assessed with transmitral flow pulsed-wave recordings and the peak early (E) and late (A) diastolic velocities as well as the E-wave deceleration time were measured. The measurement of E´ was performed with tissue Doppler imaging at the septal and lateral mitral annulus in the apical 4-chamber view.14 Finally, valvular function was assessed with 2D, color, pulsed and continuous wave Doppler echocardiography and valvular heart disease was graded according to current recommendations.15,16
LV GLS and LVMD Assesment
From 2D echocardiographic data, LV global longitudinal strain (GLS) was quantified by 2D STE on the apical 4-, 2- and long-axis views. The endocardial borders were traced at the end-systolic frame and an automated tracking algorithm outlined the myocardium in successive frames throughout the cardiac cycle.17 In addition, LVMD was quantified with 2D STE on the apical 4-chamber, 2-chamber and long-axis views. LVMD was defined as the standard deviation of time from the onset of the Q/R wave to peak longitudinal strain of 17 LV segments (Figure 1).18 The apical segment was not excluded from the analysis.
Follow-up and endpoints
Patients were followed for the occurrence of all-cause mortality (primary endpoint). Survival data were complete for all study subjects and collected from the departmental
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