Page 144 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter seven. LVMD in STEMI and prognosis
an intervention on LVMD changes and their association with long-term outcomes will need prospective studies. Similar to previous studies, we demonstrate that LVMD had incremental prognostic value over traditional clinical and echocardiographic parameters such LVEF, WMSI and even LV GLS in patients after STEMI. For our study population, the spline curve analysis showed that the mortality risk increased significantly above an LVMD value of 50 ms. Therefore, LVMD represents a promosing new parameter and may further aid in the risk stratification for contemporary STEMI patients.
Study limitations
Several limitations should be acknowledged. The current study was retrospective in nature and the data were generated from a single center. Furthermore, the measurements of LVMD may not be generalizable for all commercially available platforms for analysis of speckle tracking and the cut-off value of LVMD provided in this study may not be applicable in other study populations. In 10% of the patients, complete data on diastolic function was not available and therefore were not included in the multivariable analysis. Finally, all-cause mortality was chosen as the endpoint of our study as these data were readily available. More specific causes of death, such as ventricular arrhythmias or sudden cardiac death, were not available for all patients and could have strengthened the results of the current study.
Conclusions
After STEMI, prolonged LVMD was associated with increasing age, systolic blood pressure, diabetes mellitus, anterior STEMI, TIMI flow <2, less usage of ACEi/ARBs, worse LV GLS and heart rate at discharge. Patients after STEMI with prolonged LVMD experienced worse long-term outcome.
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