Page 175 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

adverse events in inhomogeneous populations. In contemporary STEMI patients, more prolonged LV mechanical dispersion was associated with various clinical and echocardiographic parameters. Also, more prolonged LV mechanical dispersion (higher mortality risk >50ms) was associated with worse long-term outcome (all-cause mortality) (Chapter 7).
In addition, quantification of myocardial infarct size by LGE-CMR is considered the gold standard and allows for characterisation of infarct tissue (total scar burden, infarct core and border zone). LV MD was correlated with LV scar burden (may provide as a surrogate of LV scar) and in addition, patients with prolonged LV MD showed higher event rates (all-cause mortality and appropriate implantable cardioverter defibrillator therapy). This emphasizes the fact that LV mechanical dispersion may contribute to the risk stratification of contemporary STEMI patients (Chapter 8).
CONCLUSIONS AND FUTURE PERSPECTIVES
The use of LVEF in quantifying LV systolic dysfunction, is subject to a number of limitations, many of which can partially be overcome by speckle tracking echocardiography. The best-validated parameter of LV systolic function is LV GLS, for which ample evidence has accumulated to support its use in diagnosis and risk-stratification of various cardiac diseases affecting the LV. Speckle tracking echocardiography is currently transitioning from an experimental to a routine technique, and is recommended in several clinical scenarios, particularly in those where regular surveillance of LV systolic function has therapeutic implications.
Furthermore, echocardiographic evaluation of patients with ischemic heart disease remains pivotal in both the acute setting of STEMI patients and at follow up. Using clinical, biochemical and echocardiographic parameters can allow for better risk stratification. New advances in echocardiographic software enables for more comprehensive analysis of the LV. Application of this new data in addition to conventional parameters could provide more and better prognostic information. Using this strategy, patients after STEMI could be identified early for more aggressive and more targeted treatment, or identify patients at risk whom are in need of more intensive follow up. Also, echocardiography could be an additional tool to identify patients that may benefit from treatment strategies. However, prospective studies are needed to investigate potential therapeutic consequences of these new echocardiographic derived parameters before standardized implementation will be possible.
9
169