Page 76 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter four. Left ventricular recovery after STEMI
medications at hospital discharge were grouped as: antiplatelet agents, angiotensin converter enzyme inhibitors (ACEi) or angiotensin receptor blockers II (ARB-II), beta- blockers, aldosterone antagonists, and statins. Medical treatment was optimized according to contemporary guidelines and was titrated at the discretion of the treating physician.8,9 The use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) according current guidelines were recorded.10,11 Clinical data were collected in the Cardiology Department Information System (EZIS chipsoft & EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands).
Transthoracic echocardiography was performed in patients at rest in the left lateral decubitus position using commercially available ultrasound systems (Vivid 7 and E9; General Electric Vingmed, Horten, Norway). 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 subsequent offline analysis (EchoPac BT13; GE Medical Systems, Horten, Norway). The LVEF was calculated in the apical 4- and 2-chamber views using the Simpson’s biplane method.12 The wall motion score index was defined as the total sum of the segmental scores divided by the number of segments scored.12 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 location of the mitral annulus in the apical 4-chamber view. In addition, valvular morphology and function were assessed with 2D, color and pulsed and continuous wave Doppler echocardiography following contemporary recommendations.13
Continuous variables with normal distribution are reported as mean ± standard deviation and were analysed using one-way analysis of the variance (ANOVA). Non-normally distributed data are presented as median and interquartile range (IQR) and were analysed with Kruskal-Wallis test. Categorical variables are reported as frequencies and percentages and were analysed using the χ2 test. Uni- and multivariable regression analyses were performed to examine independent correlates of LVEF recovery at 6 months follow-up. Variables with p-values <0.2 on univariable analysis were included in the multivariable analysis. Statistical analysis was performed on SPSS for Windows v23.0 (IBM, Armonk, New York). A 2-tailed p-value <0.05 was considered statistically significant.
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