Page 96 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter five. Layer-specific LV GLS and remodeling
analysis were included in the multivariable analysis. To avoid multicollinearity, a correlation coefficient of <0.7 was set. To evaluate the incremental value of layer-specific LV GLS over clinical and conventional echocardiographic parameters, layer-specific LV GLS was introduced to a fixed regression model in a stepwise manner. Global χ2 values were calculated for all models. A significant change in χ2 was considered as an incremental value. Statistical analysis was performed on SPSS for Windows v20.0 (IBM, Armonk, New York). A 2-tailed p-value <0.05 was considered statistically significant.
RESULTS
Baseline characteristics
A total of 502 patients (mean age 60± 11years, 76% male) admitted with acute STEMI were included. Table 1 summarizes the baseline clinical characteristics of the overall population. Anterior STEMI was the most frequent location (n=269; 54%) and 228 (45%) patients presented with multi-vessel disease. The median levels of peak troponin and creatinine phosphokinase were 4.9 μg/L (IQR 2.2-9.7) and 1,794 U/L (IQR 901- 3,180), respectively. Aspirin was prescribed in 97% of patients while thienopyridines were prescribed in 100% of patients. Furthermore, 97% of patients were treated with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), 95% received beta-blockers, 100% statins and 1% received aldosterone antagonists at discharge (Table 2).
Echocardiographic findings at baseline are presented in Table 3. The mean LVEF was 46±9% and the WMSI was 1.5±0.3. The mean full wall LV GLS was -13.3±3.9% while the mean values for layer-specific LV GLS were -11.6±3.0%, -13.6±3.5% and -15.6±4.1% for epi-, mid- and endocardium, respectively. Moderate to severe mitral regurgitation (MR) was observed in 30 (6%) patients.
Adverse LV remodeling at follow-up
At 6 months follow-up, 181 (36%) patients showed adverse LV remodeling (Table 1). There were no significant differences in age, gender, prevalence of cardiovascular risk factors or findings at coronary angiography between patients with versus without adverse LV remodeling. However, patients with adverse LV remodeling had significantly larger infarct size as indicated by the higher peak CPK and peak troponin levels when compared to patients without adverse LV remodeling. In addition, there were no differences on the use of cardiovascular medications and ICD implantation (Table 2).
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