Page 116 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter six. Layer-specific LV GLS and prognosis
RESULTS
Table 1 summarizes the baseline clinical characteristics of the overall population. A total of 569 patients (mean age 60±11 years, 77% male) were included. The population was divided into two groups, based on survival status at follow-up. After a median follow up of 117 (IQR 106-132) months, 95 patients (17%) died. When comparing survivors versus non-survivors, patients who died were significantly older (70±11 vs. 58±10 years, p<0.001), and more frequently male (68% vs. 79%, p=0.045), had a higher body mass index (26±4.0 vs. 26±3.7 kg/m2, p=0.037) and higher heart rates at discharge (71±14 vs. 68±12 beats/minute, p=0.014). There were no differences in frequency of cardiovascular risk factors, infarct size based on peak troponin and peak creatine kinase levels. However, non-survivors showed worse renal function (estimated glomerular filtration rate (eGFR): 81±29 vs. 99±30 ml/min/1.73m2, p<0.001) and more often presented with multi-vessel disease (53% vs. 41%, p<0.001) and Killip class ≥2 (11% vs. 2%, p<0.001). There were no differences in medication use between survivors and non- survivors. Of note, 97% of patients were discharged on ACE-inhibitors or angiotensin II receptor blockers and 94% on beta-blockers.
Baseline echocardiographic characteristics for the overall study population, survivors and non-survivors are reported in Table 2. The median LVEF was 57% (IQR 47-57) and the mean wall motion score index was 1.4±0.3. Mean LV GLS was -15.1±3.2% whereas the mean values for LV GLS at epi-, mid- and endocardium were -13.2±2.9%, -15.2±3.2% and -17.5±3.6%, respectively. We observed no difference in baseline LVEF and wall motion score index between survivors and non-survivors. Non-survivors showed significantly smaller LV volumes and more advanced diastolic dysfunction when compared to survivors (Table 2).
The mean LV GLS was more preserved in survivors when compared to non-survivors (-15.3±3.2% vs. -13.9±3.2%; p<0.001). In addition, layer-specific LV GLS analysis showed more preserved values for survivors when compared to non-survivors at the endocardium (-17.7±3.6% vs. -16.5±3.7%; p=0.005), mid-myocardium (-15.6±3.2% vs. -14.2±3.2%; p<0.001) and the epicardium (-13.4±2.8% vs. -11.9±2.8%; p<0.001).
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