Page 75 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
The implementation of guideline-based secondary preventive therapy to halt left
ventricular (LV) remodeling and prevent new coronary events has made an important
impact on the evolution of LV systolic function after ST-segment elevation myocardial
infarction (STEMI).1,2,3 Nevertheless, a substantial proportion of patients after STEMI
still remain with reduced LV systolic function.4 Data on LV systolic functional recovery
after STEMI treated with primary percutaneous coronary intervention (PCI) are
scarce and systematic echocardiographic surveillance of large STEMI populations 4 treated according to prevailing guidelines is infrequent.5,6 Therefore, the present study
evaluated 1) the prevalence of severe LV systolic dysfunction after first STEMI and 2) the effect of contemporary guideline-based therapy on the recovery of LV ejection fraction (EF) at 6 months follow-up in a homogenous cohort of STEMI patients treated with primary PCI.
METHODS
Of 2,853 patients with first acute STEMI admitted to the Leiden University Medical Center (The Netherlands) and treated with primary PCI between February 2004 and May 2013, patients with LVEF ≤40% on 2-dimensional (2D) echocardiography performed within 48 hours of admission were identified and included in the present analysis.7 At discharge, patients received guideline-based medical therapy according to contemporary guidelines. 8,9 Repeated clinical and echocardiographic evaluation was performed at 6 months, according to the institutional guideline-based pre-hospital, in-hospital and outpatient clinical care track protocol (MISSION!).7 Subsequently, patients were divided in three groups according to the LVEF at 6 months of follow- up: LVEF ≤40% (non-recovery), LVEF 41-49% (partial recovery) and LVEF ≥50% (full recovery) (Figure 1). Patients with prior myocardial infarction, re-infarction within 6 months after discharge, coronary artery bypass grafting and patients with incomplete echocardiographic data were excluded from this analysis. For retrospective analysis of clinically acquired data, the institutional review board waived the need for patient written informed consent.
Patient demographics and clinical characteristics were recorded. The culprit lesion was identified on invasive coronary angiography and the final Thrombolysis In Myocardial Infarction (TIMI) flow after primary PCI was registered. Multi-vessel disease was defined as the presence >1 vessel with luminal narrowing ≥50%. Cardiovascular
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