TY - JOUR

T1 - Post-systolic shortening predicts heart failure following acute coronary syndrome

AU - Brainin, Philip

AU - Skaarup, Kristoffer Grundtvig

AU - Iversen, Allan Zeeberg

AU - Jørgensen, Peter Godsk

AU - Platz, Elke

AU - Jensen, Jan Skov

AU - Biering-Sørensen, Tor

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - BACKGROUND: Post-systolic shortening (PSS) is a novel echocardiographic marker of myocardial dysfunction. Our objective was to assess the prognostic value of PSS in patients following acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).METHODS: A total of 428 patients hospitalized for ACS (mean age 64 ± 12 years, male 73%) underwent speckle tracking echocardiography following treatment with PCI (median 2 days). The individual endpoints were heart failure (HF), myocardial infarction (MI) and all-cause death. We excluded known HF. Presence of PSS was defined as post-systolic displacement ≥20% of maximum strain in one cardiac cycle. The post-systolic index (PSI) was defined as (100 × [maximum-strain cardiac cycle - peak-systolic strain])/(maximum-strain cardiac cycle)].RESULTS: During median follow-up of 3.7 years (IQR 0.3, 5.2), 155 patients (36%) experienced HF, 52 (12%) had MI and 87 (20%) died from all causes. Patients experiencing HF had more walls displaying PSS (3.2 vs. 1.9 walls) and higher PSI (22% vs. 12%) (P < 0.001 both). In Cox proportional hazards models adjusted for baseline characteristics, invasive and echocardiographic measurements, the risk of HF increased incrementally with increasing number of walls with PSS (HR 1.28 95%CI 1.12-1.46, P < 0.001 per 1 increase in walls with PSS). The PSI remained an independent predictor of HF after adjustment (HR 1.61 95%CI 1.21-2.12, P = 0.001 per 1% increase). In the same adjusted models, MI and all-cause death were not significantly associated with PSS.CONCLUSION: Presence of PSS provides novel and independent prognostic information regarding the risk of future HF in patients with ACS following PCI.

AB - BACKGROUND: Post-systolic shortening (PSS) is a novel echocardiographic marker of myocardial dysfunction. Our objective was to assess the prognostic value of PSS in patients following acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).METHODS: A total of 428 patients hospitalized for ACS (mean age 64 ± 12 years, male 73%) underwent speckle tracking echocardiography following treatment with PCI (median 2 days). The individual endpoints were heart failure (HF), myocardial infarction (MI) and all-cause death. We excluded known HF. Presence of PSS was defined as post-systolic displacement ≥20% of maximum strain in one cardiac cycle. The post-systolic index (PSI) was defined as (100 × [maximum-strain cardiac cycle - peak-systolic strain])/(maximum-strain cardiac cycle)].RESULTS: During median follow-up of 3.7 years (IQR 0.3, 5.2), 155 patients (36%) experienced HF, 52 (12%) had MI and 87 (20%) died from all causes. Patients experiencing HF had more walls displaying PSS (3.2 vs. 1.9 walls) and higher PSI (22% vs. 12%) (P < 0.001 both). In Cox proportional hazards models adjusted for baseline characteristics, invasive and echocardiographic measurements, the risk of HF increased incrementally with increasing number of walls with PSS (HR 1.28 95%CI 1.12-1.46, P < 0.001 per 1 increase in walls with PSS). The PSI remained an independent predictor of HF after adjustment (HR 1.61 95%CI 1.21-2.12, P = 0.001 per 1% increase). In the same adjusted models, MI and all-cause death were not significantly associated with PSS.CONCLUSION: Presence of PSS provides novel and independent prognostic information regarding the risk of future HF in patients with ACS following PCI.

KW - Acute Coronary Syndrome/diagnostic imaging

KW - Aged

KW - Cohort Studies

KW - Echocardiography/methods

KW - Female

KW - Heart Failure/diagnostic imaging

KW - Humans

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Retrospective Studies

KW - Systole/physiology

U2 - 10.1016/j.ijcard.2018.11.106

DO - 10.1016/j.ijcard.2018.11.106

M3 - Journal article

C2 - 30527346

VL - 276

SP - 191

EP - 197

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -