Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both.

Published

Journal Article

BACKGROUND: Mechanical dyssynchrony is considered an independent predictor for adverse cardiovascular outcomes in patients with heart failure. However, its importance as a risk factor after myocardial infarction is not well defined. METHODS AND RESULTS: We examined the influence of mechanical dyssynchrony on outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiography study. B-mode speckle tracking with velocity vector imaging was used to assess ventricular synchrony in 381 patients who had image quality sufficient for analysis. Time to regional peak velocity and time to strain rate were measured among 12 left ventricular segments from the apical 4- and 2- chamber views, and the SDs between all 12 segments were used as a measure of dyssynchrony. The relationships between the SD of time to regional peak velocity and strain rate and clinical outcome of death or heart failure were assessed. In a multivariate Cox model adjusted for clinical and echocardiographic variables, the SD of time to peak velocity (hazard ratio per 10 ms, 1.10; 95% confidence interval, 1.02 to 1.18; P=0.010) and the SD of time to strain rate (hazard ratio per 10 ms, 1.16; 95% confidence interval, 1.06 to 1.27; P=0.001) were independent predictors of death or heart failure. CONCLUSIONS: Left ventricular dyssynchrony is independently associated with increased risk of death or heart failure after myocardial infarction, suggesting that contractile pattern may play a role in post-myocardial infarction prognosis.

Full Text

Duke Authors

Cited Authors

  • Shin, S-H; Hung, C-L; Uno, H; Hassanein, AH; Verma, A; Bourgoun, M; Køber, L; Ghali, JK; Velazquez, EJ; Califf, RM; Pfeffer, MA; Solomon, SD; Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators,

Published Date

  • March 2010

Published In

Volume / Issue

  • 121 / 9

Start / End Page

  • 1096 - 1103

PubMed ID

  • 20176989

Pubmed Central ID

  • 20176989

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

International Standard Serial Number (ISSN)

  • 0009-7322

Digital Object Identifier (DOI)

  • 10.1161/circulationaha.109.863795

Language

  • eng