[PP.LB01.01] HIGH VALUE OF ARTERIAL STIFFNESS AS A PREDICTOR OF A LESS EFFECTIVE RECOVERY OF LEFT VENTRICULAR SYSTOLIC FUNCTION AFTER ACUTE MYOCARDIAL INFARCTION

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Abstract

Objective:

Left ventricular global-longitudinal strain (LV GLS) is an important predictor of adverse outcomes in patients with myocardial infarction (MI). GLS is more sensitive than LV ejection fraction (LVEF) as a measure of systolic function and may be used to detect reduction in LV-function prior to fall in LVEF. Pulse wave velocity (PWV), a marker of arterial stiffness, can predict cardiovascular events. The aim of the study was to investigate the relations between GLS and carotid-femoral PWV in patients with MI successfully treated with percutaneous coronary intervention (PCI).

Design and method:

93 patients with first MI and primary (PCI) (70% male, age 61.5 ± 10.1 years (M ± SD), 57 (61,3%) with ST-Elevation Myocardial Infarction (STEMI), smokers 25%, arterial hypertension 20%, blood pressure 129 ± 6/82 ± 7 mmHg, left ventricular ejection fraction (LVEF) 47.4 ± 4.3%. Arterial stiffness was assessed using applanation tonometry. GLS by speckle tracking echocardiography (STE) was calculated in a 16-segment LV-model as the average segmental value on the basis of three apical imaging planes. Mann-Whitney and Spearman tests were considered significant if p < 0.05.

Results:

Baseline GLS >18% was not detected in any patient. GLS increased from 14.3 ± 2.3 to 15.6 ± 2.4%, p < 0.04 in 4 weeks after PCI. GLS normalized (>18%) in 24 (25%) patients. Achieved GLS differed significantly in patients without vs with normalization (14.5 ± 1.8 vs 18.6 ± 0.3%, p < 0.02). Mean carotid-femoral pulse wave velocity (PWV) decreased from 11.5 ± 1.9 to 10.1 ± 2.3%, p < 0.05. Patients without vs with GLS normalization were older (63.2 ± 9.1 vs 56.6 ± 11.4 years, p < 0.04), more frequent male (71 vs 33%, χ = 7.8; p < 0.01), smokers (83 vs 50%, χ = 6.5; p < 0.05), STEMI (60 vs 67%, χ = 4.6; p < 0.03), had higher diastolic BP (84 ± 7 vs 80 ± 8 mmHg, p < 0.02), higher baseline PWV (12.9 ± 6.9 vs 9.9 ± 2.1 m/s, p < 0.03). EF increased non-significant between groups. A significant correlation was found between decreased δ speckle tracking and higher PWV (r = -0.21, p < 0.05).

Conclusions:

Improvement of systolic function assessed by GLS was revealed in 25% of patients with first MI treated with PCI. Higher baseline PVW was associated with less improvement of GLS. Arterial stiffening may result in a less effective recovery of LV longitudinal function after MI.

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