Page 78 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter four. Left ventricular recovery after STEMI
RESULTS
A total of 371 (13%) patients of 2,853 patients admitted with acute STEMI had an LVEF ≤40% within 48 hours of admission. The mean age of the patient population was 61±12 (range 33-88) years and 76% were men (Table 1). The culprit lesion was the left anterior descending coronary artery in 236 (64%) patients and 214 (58%) presented with multi- vessel disease. The median levels of peak troponin T and creatine phosphokinase were 6.5 μg/L (IQR 3.2-12.3) and 2,564 U/L (IQR 1,253-4,671), respectively. At discharge, all patients received antiplatelet therapy, 99% of patients were treated with ACEi or ARB- II, 94% received beta-blockers, 99% statins, 13% diuretics, and 6% received aldosterone antagonists. During the 6 months follow-up after index admission, 64 patients received heart failure device therapy: 37 (10%) received CRT and 24 (6.5%) an ICD.
Echocardiographic data within 48 hours of admission are presented in Table 2. The median LVEF was 36% (IQR 32-39) and the wall motion score index was 1.7±0.35. Moderate to severe mitral regurgitation was observed in 57 (15%) patients.
Table 1. Baseline characteristics for the entire study population.
LVEF at 6 months follow-up
Variable
Total population (n=371)
No recovery (LVEF≤40%) (n=115)
Partial recovery (LVEF 41- 49%) (n=111)
Full recovery (LVEF≥50%) (n=145)
p-value
Clinical characteristics
Age (years)
Men
Heart rate discharge, bpm
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Body surface area (m2) QRS duration (ms)
Hypertension Hypercholesterolemia
Family history of coronary artery disease
Diabetes mellitus Current smoker
60.5 ± 12.2 280 (76%) 74 ± 13 135 ± 26
82 ± 17
2.0 ± 0.26
90 (80- 100)
119 (32%) 60 (16%) 172 (46%)
52 (14%) 177 (48%)
60.4 ± 12.3 88 (77%) 76 ± 14 131 ± 27
81 ± 17
2.0 ± 0.3 90 (80-100)
37 (32%) 20 (33%) 57 (49%)
18 (16%) 48 (42%)
60.0 ± 12.8 84 (76%) 73 ± 12 136 ± 23
82 ± 16
2.0 ± 0.3 92 (80-100)
40 (36%) 17 (28%) 49 (44%)
17(15%) 59 (53%)
61.0 ± 11.6 108 (75%) 74 ± 13 137 ± 27
82 ± 18
2.0 ± 0.2 90 (90-100)
42 (29%) 23 (38%) 66 (46%)
17 (12%) 70 (48%)
0.815 0.929 0.130 0.197
0.625
0.475 0.743
0.354 0.506 0.940
0.747 0.428
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