Page 142 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter seven. LVMD in STEMI and prognosis
enhanced cardiac magnetic resonance (LGE-CMR).5 In addition, prolonged LVMD has also been associated with increasing myocardial fibrosis as evaluated by feature tracking CMR in patients after STEMI.19
Non-modifiable parameters such as age have been associated with prolonged LVMD.20 Age is associated with increased fibrosis and may therefore lead to prolonged LVMD.20,21 In addition, LAD STEMI has been associated with larger infarct size and, larger area of scar (fibrosis) leading to longer LVMD.22,23
Our study shows no association between history of hypertension and prolonged LVMD. However, on multivariable analysis we demonstrated that a increased systolic blood pressure is correlated with more prolonged LVMD. This finding was in line with previous studies that have shown the association between hypertension and prolonged LVMD in healthy volunteers and in a real word aging population derived from the Akerhus Cardiac examination study.20,24 Accordingly, it has been hypothesized that LV myocardial contractile heterogeneity by STE is a multifactorial process which includes factors such as ischemia and interstitial fibrosis,24 which can also be present in patients with hypertension.25,26
Furthermore, a previous study by Boudina and colleagues demonstrated that patients with diabetes mellitus appear to be more prone to cardiac injury.27 Studies have suggested that this multifactorial disease leads to increased interstitial fibrosis of the heart with reduced LV function.27 This was in concordance with a previous study by Hoogslag and co- workers 28 demonstrating that diabetes mellitus was associated with more impaired global longitudinal strain in patients after STEMI. In addition, TIMI flow grade is frequently used to correlate coronary flow before and after primary PCI with clinical outcome.29 Previous work has shown that patients who underwent PCI with initial TIMI flow grade 3 in the culprit coronary artery more often have improved early and late survival rates.30 It has been suggested that reduced TIMI flow causes reduced blood flow, thus reduced oxygen supply and may therefore lead to larger myocardial damage and larger infarct size. The use of ACEi/ARBs is recommended in current guidelines as secondary prevention after STEMI.1,2 Treatment with ACEi/ARBs inhibits LV remodelling and deterioration of LV systolic function after STEMI which in terms improves prognosis.31 We demonstrated that the usage of ACEi/ARBs is associated with shorter LVMD. ACEi/ARBs have shown to supress fibrotic remodeling, as LV remodeling after STEMI is accompanied by increased interstitial collagen deposition.32
136