Aim To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)).Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (р<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (р<0.01), and EDV and ESV indexes (EDVi and ESVi, р<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (р<0.05) and global radial strain (GRS) was decreased at 48 weeks (р=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (р=0.006); 3,4 % (р=0.001), and 2.3 % (р=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (р=0.001), rMSSD by 24 % (р=0.0002), TotP by 49 % (р=0.00002), VLfP by 23 % (р=0.003), LfP by 22 % (р=0.008), and HfP by 77 % (р=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (р=0.013) and HfP (р=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7–9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks.Conclusion The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.
A multivariate model for predicting the risk of decompensated chronic heart failure (CHF) within 48 weeks after ST-segment elevation myocardial infarction (STEMI) has been developed and tested. Methods. The study included 173 patients with acute STEMI aged 51.4 (95% confidence interval (CI): 42–61) years. Two-dimensional (2D) speckle-tracking echocardiography (STE) has been performed on the 7th–9th days, and at the 12th, 24th, and 48th weeks after the index event with the analysis of volumetric parameters and values for global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS). A 24-h ECG monitoring (24 h ECG) of the electrocardiogram (ECG) to assess heart rate turbulence (HRT) has been performed on the 7th–9th days of STEMI. The study involved two stages of implementation. At the first stage, a multivariate model to assess the risk of CHF progression within 48 weeks after STEMI has been built on the basis of examination and follow-up data for 113 patients (group M). At the second stage, the performance of the model has been assessed based on a 48-week follow-up of 60 patients (group T). Results. A multivariate regression model for CHF progression in STEMI patients has been created based on the results of the first stage. It included the following parameters: HRT, left ventricular (LV) end-systolic dimension (ESD), and GLS. The contribution of each factor for the relative risk (RR) of decompensated CHF has been found: 3.92 (95% CI: 1.66–9.25) (p = 0.0018) for HRT; 1.04 (95% CI: 1.015–1.07) (p = 0.0027) for ESD; 0.9 (95% CI: 0.815–0.98) (p = 0.028) for GLS. The diagnostic efficiency of the proposed model has been evaluated at the second stage. It appeared to have a high specificity of 83.3%, a sensitivity of 95.8%, and a diagnostic accuracy of 93.3%. Conclusion. The developed model for predicting CHF progression within 48 weeks after STEMI has a high diagnostic efficiency and can be used in early stages of myocardial infarction to stratify the risk of patients.
Funding Acknowledgements Type of funding sources: None. Purpose to assess the relationship of indicators of global myocardial work of the left ventricle (LV) in patients with ST-segment elevation myocardial infarction (STEMI) with hemodynamic and deformation parameters that traditionally characterize the systolic function of the heart. Methods 45 people with primary STEMI were included: 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). Myocardial infarction was confirmed by ECG, biomarkers (troponin I, CPK-MB) and by the results of coronary angiography. Echocardiography has been performed on the 7-9th day of STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). EchoPAC software version 202 (GE Healthcare) has been used. The end-diastolic volume index (EDVi, ml / m2), end-systolic volume index (ESVi, ml / m2), LV ejection fraction (EF,%) have been assessed using the Simpson biplane method. The global longitudinal strain (GLS,%) has been determined using the speckle-tracking echocardiography method. The indicators of myocardial work have been automatically calculated: the index of global myocardial work (GWI, mm Hg%), global constructive work (GCW, mm Hg%), and global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing has been performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results the average values of the determined parameters were the following: LVEF - 49.4 ± 6.7%, EDVi - 62.8 ± 12.7 ml / m2, ESVi - 32 ± 8.9 ml / m2, GLS - (-13, 5) ± 4%, GWI - 1192.4 ± 416.2 mm Hg%, GWE - 88.9 ± 6.5%, GCW - 1362.1 ± 442.5 mm Hg%, GWW - 98.5 (69; 130) mm Hg%. The values of the correlation coefficient GWI were: with EF (r = 0.26; p = 0.19), with EDVi (r = -0.3; p = 0.12), with ESVi (r = -0.35; p = 0.07), with GLS (r = 0.85; p = 0.000002). GWE had the following correlation coefficient values: with EF (r = 0.17; p = 0.39), with EDVi (r = -0.42; p = 0.026), with ESVi (r = -0.4; p = 0.025), with GLS (r = 0.74; p = 0.00001). The correlation coefficient of GCW with EF was 0.24 (p = 0.24), with EDVi - (-0.26) (p = 0.19), with ESVi - (- 0.3) (p = 0.1), with GLS - 0.85 (p = 0.000004). The correlation coefficient of GWW with EF was -0.02 (p = 0.9), with EDVi - 0.26 (p = 0.17), with ESVi - 0.2 (p = 0.3), with GLS - 0.37 (p = 0.06). Conclusion the analysis of the correlations between the indicators of myocardial work and the determined parameters revealed that GWE had a moderate correlation with EDVi, ESVi. Parameters GWI, GWE, GCW had a strong correlation with GLS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.