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Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction.

Publication ,  Journal Article
Ersbøll, M; Valeur, N; Andersen, MJ; Mogensen, UM; Vinther, M; Svendsen, JH; Møller, JE; Kisslo, J; Velazquez, EJ; Hassager, C; Søgaard, P; Køber, L
Published in: JACC Cardiovasc Imaging
August 2013

OBJECTIVES: This study sought to hypothesize that global longitudinal strain (GLS) as a measure of infarct size, and mechanical dispersion (MD) as a measure of myocardial deformation heterogeneity, would be of incremental importance for the prediction of sudden cardiac death (SCD) or malignant ventricular arrhythmias (VA) after acute myocardial infarction (MI). BACKGROUND: SCD after acute MI is a rare but potentially preventable late complication predominantly caused by malignant VA. Novel echocardiographic parameters such as GLS and MD have previously been shown to identify patients with chronic ischemic heart failure at increased risk for arrhythmic events. Risk prediction during admission for acute MI is important because a majority of SCD events occur in the early period after hospital discharge. METHODS: We prospectively included patients with acute MI and performed echocardiography, with measurements of GLS and MD defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite endpoint (SCD, admission with VA, or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator [ICD]) was analyzed with Cox models. RESULTS: A total of 988 patients (mean age: 62.6 ± 12.1 years; 72% male) were included, of whom 34 (3.4%) experienced the primary composite outcome (median follow-up: 29.7 months). GLS (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 1.25 to 1.53; p < 0.0001) and MD (HR/10 ms: 1.38; 95% CI: 1.24 to 1.55; p < 0.0001) were significantly related to the primary endpoint. GLS (HR: 1.24; 95% CI: 1.10 to 1.40; p = 0.0004) and MD (HR/10 ms: 1.15; 95% CI: 1.01 to 1.31; p = 0.0320) remained independently prognostic after multivariate adjustment. Integrated diagnostic improvement (IDI) and net reclassification index (NRI) were significant for the addition of GLS (IDI: 4.4% [p < 0.05]; NRI: 29.6% [p < 0.05]), whereas MD did not improve risk reclassification when GLS was known. CONCLUSIONS: Both GLS and MD were significantly and independently related to SCD/VA in these patients with acute MI and, in particular, GLS improved risk stratification above and beyond existing risk factors.

Duke Scholars

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2013

Volume

6

Issue

8

Start / End Page

851 / 860

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Primary Prevention
  • Predictive Value of Tests
  • Myocardial Infarction
  • Multivariate Analysis
 

Citation

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MLA
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Ersbøll, M., Valeur, N., Andersen, M. J., Mogensen, U. M., Vinther, M., Svendsen, J. H., … Køber, L. (2013). Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction. JACC Cardiovasc Imaging, 6(8), 851–860. https://doi.org/10.1016/j.jcmg.2013.05.009
Ersbøll, Mads, Nana Valeur, Mads Jønsson Andersen, Ulrik M. Mogensen, Michael Vinther, Jesper Hastrup Svendsen, Jacob Eifer Møller, et al. “Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction.JACC Cardiovasc Imaging 6, no. 8 (August 2013): 851–60. https://doi.org/10.1016/j.jcmg.2013.05.009.
Ersbøll M, Valeur N, Andersen MJ, Mogensen UM, Vinther M, Svendsen JH, et al. Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction. JACC Cardiovasc Imaging. 2013 Aug;6(8):851–60.
Ersbøll, Mads, et al. “Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction.JACC Cardiovasc Imaging, vol. 6, no. 8, Aug. 2013, pp. 851–60. Pubmed, doi:10.1016/j.jcmg.2013.05.009.
Ersbøll M, Valeur N, Andersen MJ, Mogensen UM, Vinther M, Svendsen JH, Møller JE, Kisslo J, Velazquez EJ, Hassager C, Søgaard P, Køber L. Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction. JACC Cardiovasc Imaging. 2013 Aug;6(8):851–860.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2013

Volume

6

Issue

8

Start / End Page

851 / 860

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Primary Prevention
  • Predictive Value of Tests
  • Myocardial Infarction
  • Multivariate Analysis