571 Echo-Omics to estimate prognosis after an acute myocardial infarction: which one to pic?

Abstract

BACKGROUND Simple and reproducible echocardiographic parameters are still the cornerstone of daily clinical practice. These data provides important information for the evaluation of patients with ST-segment elevation myocardial infarction (STEMI). The identification of prognostic echocardiographic parameters in STEMI would help in risk stratification. PURPOSE To evaluate the discriminatory capacity of echocardiographic parameters after a STEMI. METHODS Single centre retrospective observational study of 303 patients with STEMI who survived hospital stay and had a complete echocardiographic evaluation. The following ecocardiographic parameters were collected at discharge: left ventricular (LV) systolic and diastolic volumes; septal and posterior wall thickness; LV ejection fraction (LVEF); left atrial (LA) diameter; estimated systolic pulmonary artery pressure (SPAP). One year and long-term all cause mortality were analyzed. RESULTS For the patients enrolled (71% males, 64.6 ± 14.1 years old), peak troponin I was 99.1 ± 126.5 ng/mL; mean GRACE score was 153.6 ± 38.8 points and mean LVEF was 46.2 ± 11.2%. One year mortality was 8.3% and during a median 73 months follow-up, 25.1% patients were deceased. After adjustment for echocardiographic variables in a Cox regression model, SPAP (HR 1.07, 95%CI 1.02-1.12, P = 0.007) and septal thickness (HR 1.36, 95%CI 1.08-1.73, P = 0.01) were both independently associated with one year mortality. A Kaplan-Meier survival methodology using stratified SPAP and septal thickness showed a trend of different event rate (log rank P = 0.003 and P = 0.035, respectively), with a gradation of cumulative risk for all-cause mortality, with a sharp increase at >40mmHg and >11mm, respectively. Regarding longterm follow-up, only increased SPAP proved to be an independent predictor of mortality (HR 1.04, 95%CI 1.01-1.08, P = 0.016). The difference in favor of an SPAP <33mmHg (sensitivity 86.67% and specificity 54.1%) was seen early after the STEMI event and maintained at each interim analysis (log rank P = 0.002). Upon the visual analysis of the cubic spline curves, patients with SPAP < ± 30mmHg had a good long-term survival. No association of LV volumes or LVEF was noted for both one year and long-term mortality. CONCLUSION Classic echocardiographic parameters still have a role to estimate prognosis after STEMI. Estimated SPAP had the greatest discriminatory capabilities, surpassing left ventricular ejection fraction! Abstract 571 FIGURE 1

EuroEcho 2019: highlights

“…Schuster et al (18) presented data demonstrating that with RVEF <61.3%, impairment of all three elements of RA function were associated with a significant increase in MACE. De Campos et al (19) presented further data relating to the impact of right heart function on outcomes post-myocardial infarction. Numerous variables (physiological, biological, echocardiographic) were studied post-myocardial infarction in 303 patients with follow up at short-and long-term (i.e.…”