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Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction

  • Philip Brainin
  • Sune Haahr-Pedersen
  • Morten Sengeløv
  • Flemming Javier Olsen
  • Thomas Fritz-Hansen
  • Jan Skov Jensen
  • Tor Biering-Sørensen
Original Paper

Abstract

Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1–3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1–6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02–3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09–1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08–2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.

Keywords

Late systolic shortening Echocardiographic measures Prognostic Adverse cardiovascular outcome Tissue-Doppler Speckle tracking echocardiography Strain 

Notes

Compliance with ethical standards

Conflict of interest

The corresponding author declares on behalf of all authors that there are no conflicts of interests.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Cardiology, Herlev and Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark

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