Page 138 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter seven. LVMD in STEMI and prognosis
Follow-up
After a median follow-up of 117 (IQR 104-132) months, 229 patients (23%) died. The population was divided into two groups, based on survival status. Baseline clinical characteristics are reported in Table 1. When comparing survivors versus non-survivors, patients who died were significantly older, had more often diabetes and higher prevalence of prior myocardial infarction. Additionally, non-survivors showed larger infarct size as indicated by higher peak troponin levels, worse renal function and more often presented with multi-vessel coronary artery disease. Furthermore, aspirin, thienopyridines, ACEi/ ARBs, β-blockers and statins were less frequently prescribed among non-survivors as compared to survivors. Baseline echocardiographic characteristics in survivors and non- survivors are reported in Table 2. Patients who died had a significantly lower LVEF, more impaired LV GLS and larger LVMD when compared to survivors. Furthermore, non-survivors showed larger indexed LV mass, higher values of WMSI, more diastolic dysfunction and a higher frequency of significant mitral regurgitation when compared to survivors.
Survival analysis
The Kaplan-Meier curves for all-cause mortality are shown in Figure 2, with the population divided into two groups according the median LVMD (≥54 ms vs. <54 ms). The cumulative event-free survival was significantly higher for patients with LVMD <54 ms as compared to patients with LVMD ≥54 ms (χ2= 33.398, log-rank p<0.001). Univariable associates of all-cause mortality are shown in Table 4. Age, hypertension, diabetes mellitus, previous myocardial infarction, QRS duration, multi-vessel disease, TIMI flow ≥2, Killip class ≥2, higher peak troponin levels, lower eGFR, lower body mass index, less use of ACEi/ARBs and β-blockers, higher heart rate at discharge, higher WMSI, significant mitral regurgitation, lower LVEF, larger indexed LV mass, worse LV GLS and larger LVMD were significant univariable associates of all-cause mortality and therefore introduced into the multivariable model. On multivariable Cox regression analysis, age, diabetes mellitus, multi-vessel disease, TIMI flow≥ 2, lower LVEF and larger LVMD were independently associated with all-cause mortality. Finally, a spline curve was built for LVMD vs. all-cause mortality to illustrate the change in relative risk across the spectrum of LVMD. The assumption of linearity was not violated (χ25.69; p=0.064). With larger LVMD, there was a gradual increase of the relative risk of mortality. Particularly, a value of LVMD> 50 ms was associated with an excess of mortality (Figure 3A). Beyond 140 ms, the spline curve plateaued (Figure 3A). When adjusted for clinical and echocardiographic characteristics (age, hypertension, diabetes mellitus, previous myocardial infarction, QRS duration, multi-vessel disease, TIMI flow ≥2, Killip class ≥2, peak troponin levels, eGFR, body mass index, usage of ACEi/ARBs and β-blockers, heart rate at discharge, WMSI, mitral regurgitation ≥2, LVEF, indexed LV mass and LV
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