Page 131 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Left ventricular (LV) ejection fraction (EF) is the main parameter used in clinical practice for risk stratification of patients after ST-segment elevation myocardial infarction (STEMI).1,2 However, LVEF is highly dependent on hemodynamic conditions and lacks specificity to identify those patients who are at high risk for lethal ventricular arrhythmias.3 Recently, LV mechanical dispersion (MD) assessed by two-dimensional (2D) speckle tracking echocardiography (STE) has been proposed as a measurement of regional heterogeneity of myocardial contraction throughout the cardiac cycle and has shown to be associated with prognosis.4-11 Particularly in ischemic heart disease, LVMD by 2D-STE has been proven to be superior over LVEF to predict adverse events.4,6,7 The correlates of LVMD after STEMI have not been investigated and therefore there is a paucity of data regarding the factors that may influence LVMD and how LVMD influences the outcome of STEMI patients. Therefore, the aim of the current study was to investigate the correlates of LVMD shortly after STEMI and to assess the long-term implications of LVMD in a contemporary cohort of STEMI patients.
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METHODS
Population
Patients admitted with an acute STEMI to the department of Cardiology of the Leiden University Medical Center (Leiden, The Netherlands) and treated with primary percutaneous coronary intervention (PCI) between May 2004 and July 2008 were evaluated retrospectively. All patients were treated systematically according to the institutional guideline-based protocol.12 Patients were excluded if echocardiographic data within 48 hours of admission were not available or when STE strain analysis was not feasible with the software EchoPAC (BT13; GE Medical Systems, Horten, Norway). Demographic, clinical and echocardiographic data were acquired prospectively and retrospectively analysed. Patients were followed-up at the outpatient clinic as per institutional clinical care track. The Institutional Review Board approved this retrospective analysis evaluating the association between non-invasive cardiac imaging data and outcomes of STEMI patients. Due to the retrospective analysis and anonymously handling of clinically acquired data, the Institutional Review Board waived the need for written patient informed consent.
Clinical data
Patient demographics and clinical characteristics were recorded during index admission of STEMI. All patients were treated according to contemporary guidelines.1,2
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