Page 130 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

ABSTRACT
Left ventricular mechanical dispersion (LVMD) measured with speckle tracking echocardiography (STE) after ST-segment elevation myocardial infarction (STEMI) has been proposed as a measurement of regional heterogeneity of myocardial contraction and may reflect changes in the myocardial structure (e.g. fibrosis or edema). Further insight into this parameter may aid in the risk stratification of STEMI patients. A total of 1,000 STEMI patients (77% male, 60±12 years) treated with primary percutaneous coronary intervention were retrospectively analysed. LVMD was assessed with 2-dimensional STE within 48 hours following the index infarction. Patients were followed for the occurrence of all-cause mortality. After a median follow-up of 117 months, 229 (23%) patients died. Non-survivors showed worse LV ejection fraction (EF) (43±10% vs. 48±9%, p<0.001) and global longitudinal strain (GLS) (-12.0±3.5% vs. -14.2±3.5%, p=0.001) and prolonged LVMD (63 (IQR 50-85) ms vs. 52 (IQR 42-63) ms, p<0.001) as compared to survivors. Increasing age, systolic blood pressure, and heart rate at discharge, diabetes mellitus, anterior STEMI, TIMI flow <2, less usage of angiotensin converter enzyme inhibitors or angiotensin receptor blockers and impaired LV GLS were independently associated with more prolonged LVMD. On multivariable analysis, larger LVMD was independently associated with increased risk of all-cause mortality (hazard ratio 1.012 (-;95% CI: 1.005-1.018; p=0.001) and had incremental value for all-cause mortality over clinical and echocardiographic parameters.In contemporary STEMI patients, prolonged LVMD was associated with various clinical and echocardiographic parameters. More prolonged LVMD was associated with worse long-term outcome.