Page 80 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter four. Left ventricular recovery after STEMI
were no significant differences in age, gender and prevalence of cardiovascular risk factors across the 3 groups (Table 1). Patients who showed full LVEF recovery had significantly lower frequency of anterior STEMI, smaller infarct size as indicated by the lower peak CPK and troponin T levels and shorter delay from onset symptoms to balloon inflation compared with the other groups. There were no differences regarding the usage of ACEi, ARB-II, beta-blockers, statins and antiplatelet therapy across the groups. However, patients without recovery of LVEF used more frequently diuretics and aldosterone antagonists and consequently received more frequently CRT and ICD devices (Table 1).
In terms of baseline echocardiographic characteristics, patients who showed full LVEF recovery had significantly smaller LV volumes and higher LVEF within 48 hours of admission as compared with the other groups (Table 2). Furthermore, patients with recovered LVEF had lower values of wall motion score index and less frequently showed significant mitral regurgitation compared with the other groups (Table 2).
Table 2. Baseline echocardiographic characteristics for the entire study population.
LVEF at 6 months follow-up
Variable
Total population (n=371)
No recovery (LVEF≤40%) (n=115)
Partial recovery (LVEF 41-49%) (n=111)
Full recovery (LVEF≥50%) (n=145)
p-value
LV mass index (g/m2)
LV end-diastolic volume (ml)
LV end-systolic volume (ml)
LV ejection fraction (%)
Wall motion score index
Significant mitral regurgitationⱡ
E-wave velocity (cm/s) A-wave velocity (cm/s) E-prime (cm/s)
E/A ratio
Deceleration time (ms)
113 ± 33 107 (87-136)
70 (56-89)
36 (32-39) 1.7 ± 0.35
57 (15%)
62 ± 18
70 ± 20 5.0 ± 1.9 0.95 ± 0.4 230 ± 730
118 ± 35
117 (101- 148)
80 (64-101)
35 (29-38) 1.8 ± 0.38
36 (32%)
62 ± 19
70 ± 21 4.5 ± 1.6 0.95 ± 0.4 186 ± 81
110 ± 31 108 (92-141)
70 (58-90)
36 (32-39) 1.7 ± 0.30
12 (11%)
62 ± 18
71 ± 18 5.2 ± 1.9 0.92 ± 0.4 321 ± 1333
112 ± 33 101 (77-118)
64 (49-76)
37 (34-39) 1.6 ± 0.31
9 (6%)
61 ± 17
69 ± 21 5.2 ± 2.0 0.96 ± 0.4 195 ± 68
0.190 <0.001
<0.001
0.003 <0.001
<0.001
0.710 0.631 0.008 0.771 0.295
Data are presented as mean ± standard deviation, number (percentage) or as median (25th- 75th percentile). LV = left ventricular. p-values are presented for the comparisons between the different types of groups. ⱡSignificant mitral regurgitation was defined as moderate or severe mitral regurgitation
Uni- and multivariable analyses were performed to evaluate the correlates of full LVEF recovery
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