Page 153 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Myocardial infarct size is an important determinant of poor outcome after ST- segment elevation myocardial infarction (STEMI).1 Among several methods to assess infarct size 2, late gadolinium contrast enhanced cardiac magnetic resonance (LGE-CMR) is considered the gold standard.3 Furthermore, LGE-CMR allows for the characterization of infarct tissue heterogeneity, differentiating between infarct core and border zone.4 LV mechanical dispersion (MD) by two-dimensional (2D) speckle tracking echocardiography (STE) measures the timing of peak segmental myocardial shortening and has been proposed as parameter reflecting the heterogeneity of the electrical conduction.5,6 Prolonged LV MD after myocardial infarction has been associated with poor outcomes.5-8 However, the association between total myocardial scar and heterogeneity of myocardial scar tissue as assessed with LGE-CMR and LV MD measured with speckle tracking echocardiography has not been investigated. Therefore, our aim is to investigate 1) the association between LV MD and the extent of LV scar burden as evaluated by LGE-CMR and 2) the prognostic implications of LV MD compared to LGE-CMR variables in a contemporary STEMI group.
METHODS 8 Population
Patients with first acute STEMI and treated with primary percutaneous coronary intervention (PCI) between February 2004 and April 2017 were evaluated retrospectively.
All patients were treated according to the institutional, guideline-based, clinical care track protocol (MISSION!).9 Late gadolinium contrast enhanced LGE-CMR was performed in a subgroup of patients at the discretion of the treating physician to evaluate cardiac function and the extent of myocardial scar. For this substudy, STEMI patients with analysable 2D STE analysis and LGE-CMR were evaluated. Patients with prior myocardial infarction, coronary artery bypass grafting, non-feasible 2D STE analysis or LGE-CMR performed within 30 days of index myocardial infarction were excluded (Figure 1).
Clinical data
Patient demographics and clinical characteristics were recorded. The culprit lesion was identified on invasive coronary angiography at the time of intervention. The final Thrombolysis In Myocardial Infarction (TIMI) flow after primary PCI was registered. Multi-vessel disease was defined as the presence of more than ≥50% luminal narrowing in more than 1 coronary artery. Cardiovascular medications at hospital discharge
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