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Effects of left and right ventricular diastolic function parameters on one-year prognosis of patients after primary transcutaneous intervention for ST elevation myocardial infarction

Sumin A. N., Galimzyanov D. M., Sergeeva T. Yu., Barbarash O. L.

Keywords: diastolic dysfunction of the left ventricle, diastolic dysfunction of the right ventricle, myocardial infarction, prognosis, transcutaneous coronary intervention

DOI: 10.18087/rhfj.2014.1.1895

Background. Log-term prognosis for patients who have had ST elevation myocardial infarction (STEMI) is determined by both clinical factors and parameters of LV systolic and diastolic function. In patients with STEMI, primary transcutaneous intervention (TCI) significantly improves both the response to hospital treatment and the remote outcome, which may change relative contributions of various predictive factors. Aim. To evaluate the predictive value of RV and LV diastolic function and other clinical and EchoCG parameters following a primary TCI in patients with STEMI. Materials and methods. The study included 79 patients with STEMI after a primary TCI with stenting of the infarct-related artery. EchoCG was recorded at 1 and 12 days of disease with evaluation of ventricular systolic and diastolic function. Over one year, one patient had a fatal outcome, 15 patients had recurrent MI, 3 patients had stroke, and 11 patients had repeated revascularization. 46 patients did not and 23 patients had cardiovascular events. These groups of patients were compared by clinical and historical data, laboratory data, and parameters of intracardiac hemodynamics at 1 and 12 days of disease. Results. The groups differed in duration of arterial hypertension (AH) (р=0.042) and presence of multi-vessel coronary disease (р=0.034). At 12 days, the group of unfavorable prognosis had increased Еm / еm ratio (р=0.051), reduced еm (р=0.084), and increased RV isovolumetric relaxation time (IRT) (р=0.0039). The following factors correlated with the unfavorable prognosis: smoking (р=0.040), AH duration (р=0.024), multi-vessel coronary artery disease (р=0.035), and changes in the Em deceleration time (DT) during the hospital treatment (р=0.009). Multifactorial analysis showed that only Em DT correlated with the unfavorable prognosis (р=0.038). Conclusion. The one-year unfavorable prognosis in patients with STEMI correlated with the number of affected coronary arteries, AH duration, and changes in Em DT during the hospital treatment. Primary TCI not only improved the one-year prognosis in patients with STEMI but also moderated the predictive value of EchoCG parameters in these patients.
  1. Moller JE, Hillis GS, Oh JK et al. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J. 2006;151 (2):419–425.
  2. Antoni ML, Mollema SA, Delgado V et al. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010;31 (13):1640–1647.
  3. Сумин А. Н., Кобякова О. В., Галимзянов Д. М. Прогностическое значение показателей диастолической функции левого желудочка и мышечного статуса у пожилых пациентов, перенесших инфаркт миокарда. Кардиология. 2007;47 (6):45–50.
  4. Meta-Analysis Research Group in Echocardiography (MeRGE) AMI Collaborators. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation. 2008;117 (20):2591–2598.
  5. Беленков Ю. Н., Агманова Э. Т. Возможности тканевой доп­плеровской эхокардиографиии в диагностике диастолической функции правого желудочка у больных с хронической сердечной недостаточностью I–IV функционального класса. Кардиология. 2007;47 (5):4–9.
  6. Giovanardi P, Tincani E, Rossi R et al. Right ventricular function predicts cardiovascular events in outpatients with stable cardiovascular diseases: preliminary results. Intern Emerg Med. 2012;7 (3):251–256.
  7. Yamaguchi M, Tsuruda T, Watanabe Y et al. Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction. Cardiovasc Ultrasound. 2013;11 (1):19.
  8. Zaborska B, Makowska E, Pilichowska E et al. The diagnostic and prognostic value of right ventricular myocardial velocities in inferior myocardial infarction treated with primary percutaneous intervention. Kardiol Pol. 2011;69 (10):1054–1061.
  9. Bayata S, Avc? E, Yesil M et al. Tricuspid annular motion in right coronary artery-related acute inferior myocardial infarction with or without right ventricular involvement. Anadolu Kardiyol Derg. 2011;11 (6):504–508.
  10. Antoni ML, Hoogslag GE, Boden H et al. Cardiovascular morta­lity and heart failure risk score for patients after ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention (Data from the Leiden MISSION! Infarct Registry). Am J Cardiol. 2012;109 (2):187–194.
  11. Сумин А. Н., Галимзянов Д. М., Сергеева Т. Ю., Барбараш О. Л. Динамика показателей диастолической функции правого желудочков у больных острым коронарным синдромом после проведения чрескатетерного коронарного вмешательства. Журнал Сердечная недостаточность. 2012;13 (6):334–341.
  12. Агеев Ф. Т., Овчинников А. Г. Давление наполнения левого желудочка: механизмы развития и ультразвуковая оценка. Журнал Сердечная недостаточность. 2012;13 (5):287–309.
  13. Shanks M, Ng AC, van de Veire NR et al. Incremental prognostic value of novel left ventricular diastolic indexes for prediction of clinical outcome in patients with ST-elevation myocardial infarction. Am J Cardiol. 2010;105 (5):592–597.
  14. Antoni ML, Ten Brinke EA, Marsan NA et al. Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle-tracking strain imaging. J Am Soc Echocardiogr. 2011;24 (10):1126–1133.
  15. Сумин А. Н., Галимзянов Д. М., Сергеева Т. Ю., Барбараш О. Л. Влияние реваскуляризации миокарда на показатели распространения раннедиастолического потока в левом желудочке у больных острым инфарктом миокарда. Сердце. 2013;12 (1):21–27.
  16. Otasevic P, Neskovic AN, Popovic Z et al. Short early filling dece­leration time on day 1 after acute myocardial infarction is associated with short and long term left ventricular remodeling. Heart. 2001;85 (5):527–532.
  17. Schwammenthal E, Adler Y, Amichai K et al. Prognostic value of global myocardial performance indices in acute myocardial infarction: comparison to measures of systolic and diastolic left ventricular function. Chest. 2003;124 (5):1645–1651.
  18. Møller JE, Egstrup K, Køber L et al. Prognostic Importance of Systolic and Diastolic Function After Acute Myocardial Infarction. Am Heart J. 2003;145 (1):147–153.
  19. Cerisano G, Bolognese L, Buonamici P et al. Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction. J Am Coll Cardiol. 2001;37 (3):793–799.
  20. Hillis GS, Moller JE, Pellikka PA et al. Noninvasive estimation of left ventricular filling pressure by E / e' is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol. 2004;43 (3):360–367.
  21. Møller JE, Søndergaard E, Seward JB et al. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. J Am Coll Cardiol. 2000;35 (2):363–370.
  22. Morishima I, Sone T, Okumura K et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acutemyocardial infarction. J Am Coll Cardiol. 2000;36 (4):1202–1209.
  23. Nucifora G, Delgado V, Bertini M et al. Left ventricular muscle and fluid mechanics in acute myocardial infarction. Am J Cardiol. 2010;106 (10):1404–1409.
  24. Fischer-Rasokat U, Honold J, Seeger FH et al. Early remodeling processes as predictors of diastolic function 5 years after reperfused acute myocardial infarction and intracoronary progenitor cell application.Clin Res Cardiol. 2012;101 (3):209–216.
  25. Prasad SB, See V, Brown P et al. Impact of duration of ischemia on left ventricular diastolic properties following reperfusion for acute myocardial infarction. Am J Cardiol. 2011;108 (3):348–354.
  26. Zito C, Sengupta PP, Di Bella G et al. Myocardial deformation and rotational mechanics in revascularized single vessel disease patients 2 years after ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown). 2011;12 (9):635–642.
  27. Anavekar NS, Skali H, Bourgoun M et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol. 2008;101 (5):607–612.
  28. Antoni ML, Scherptong RW, Atary JZ et al. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging. 2010;3 (3):264–271.
  29. Сумин А. Н., Архипов О. Г. Показатели диастолической функции правого желудочка при различной выраженности легочной гипертензии у больных с хроническим легочным сердцем. Журнал Сердечная недостаточность. 2012;13 (1):13–18.
  30. Akdemir R, Karakurt O, Kilic H et al. Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty. Heart Vessels. 2010;25 (2):87–91.
  31. Szymański P, Rezler J, Stec S, Budaj A. Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clin Cardiol. 2002;25 (8):378–383.
  32. Souza LP, Campos O, Peres CA et al. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function? Cardiovasc Ultrasound. 2011 Jun 3;9:17.
  33. Fukuda Y, Soeki T, Sata M. A novel Doppler echocardiographic index integrating left and right ventricular function is superior to conventional indices for predicting adverse outcome of acute myocardial infarction. J Med Invest. 2013;60 (1–2):97–105.
Sumin A. N., Galimzyanov D. M., Sergeeva T. Yu. et al. Effects of left and right ventricular diastolic function parameters on one-year prognosis of patients after primary transcutaneous intervention for ST elevation myocardial infarction. Russian Heart Failure Journal. 2014;15(1):14–22.

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