The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome

Abstract

BackgroundEchocardiography is a well-established tool for risk stratification in patients with acute coronary syndrome (ACS). ACS has significant impact on LV dyssynchrony, and detrimental effects on systolic function and long term outcome. The aims of this study were to determine whether LV dyssynchrony carries any predictive information in an unselected ACS population and to evaluate if it has any incremental value to the information given from conventional echocardiographic measurements.MethodsThe study included 227 consecutive ACS patients. Primary endpoint was the composite of death, new MI, or rehospitalisation due to heart failure. Dyssynchrony was measured as intersegmental variation of time to peak strain, the post systolic index (PSI) and myocardial performance index (MPI) with the standard deviation and difference between lowest and highest value (delta) expressing the amount of dyssynchrony. Septal-lateral delay was also tested. All dyssynchrony parameters were compared with Ejection fraction (EF).ResultsThe median follow up time was 53 months. 85 patients reached the combined endpoint. Patients with and without a subsequent combined endpoint differed significantly regarding calculated SD: s and delta-value for PSI, time to peak 2D-strain and MPI but not regarding septal-lateral delay. In ROC-analysis none of the dyssynchrony parameters had larger AUC than EF. When adjusting for traditional risk factors none of the dyssynchrony parameters remained associated with outcome, whereas EF still did.ConclusionLV dyssynchrony seem to have significant prognostic information in patient with acute coronary syndrome but in comparison to conventional parameters such as EF there is no incremental value of this information.

Long-term clinical outcome in patients with acute coronary syndrome and dysglycaemia

“…Furthermore, the prevalence of systolic left ventricular (LV) dysfunction measured by echocardiography was significantly higher in patients with known diabetes. Echocardiographic parameters such as ejection fraction and myocardial strain reflecting LV systolic function, are associated with clinical outcome in patients with myocardial infarction [ 19 , 20 ], and LV function is one the strongest predictors of outcome following PCI [ 21 ].…”

The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT

“…The regular ventricular synchrony is necessary for the regular functioning of normal cardiac pump. The presence of LVD leads to reduced cardiac output, increased left ventricular end-systolic volume, delayed relaxation and inefficient LV contraction [8][9][10]. Thus, the early diagnosis of LVD is very important in patients with hypertension to prevent this clinical situation.…”

The prognostic value of Tei index in acute myocardial infarction: a systematic review

“…Studies in the literature evaluating the prognostic value Tei index after AMI are inconsistent with studies reporting an association between a greater Tei index and adverse events ( 15 , 16 , 17 , 18 ). Whilst other studies either conclude there to be no association ( 19 ) or, that Tei index offer no additional benefit over the more routinely used LVEF measurement ( 20 ). In view of the importance of understanding the prognostic value of the Tei index in AMI patients and the inconsistencies reported, we conducted a systematic review of the literature to evaluate what is currently known.…”