LV Dyssynchrony Has Prognostic Value After Acute MI

Prognostic value found for patients admitted with ST-segment elevation AMI treated with primary PCI

TUESDAY, Dec. 6 (HealthDay News) -- In patients admitted with ST-segment elevation acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI), left ventricular (LV) dyssynchrony is a strong predictor of long-term mortality and hospitalization for heart failure, over known clinical and echocardiographic risk factors, according to research published in the Dec. 15 issue of The American Journal of Cardiology.

M. Louisa Antoni, M.D., of the Leiden University Medical Center in the Netherlands, and colleagues prospectively evaluated data from 976 consecutive patients (mean age, 61 years; 77 percent men) admitted with ST-segment elevation AMI treated with primary PCI who underwent two-dimensional echocardiography with speckle-tracking imaging within 48 hours of admission to assess LV dyssynchrony. In this group of patients, mean LV dyssynchrony (or the time difference between the earliest and latest activated segments) within 48 hours of AMI was 61 ± 79 ms, with 14 percent of patients demonstrating significant LV dyssynchrony, defined as a ≥130-ms time difference.

According to the researchers, during the mean follow-up period of 40 ± 17 months, 8 percent (82/976) of patients reached the primary end point of all-cause mortality, and 4 percent (36/976) of patients were hospitalized for heart failure. In fact, for every 10-ms increase in LV dyssynchrony, the risk of all-cause mortality and hospitalization increased by 6 percent (adjusted hazard ratio per 10-ms increase, 1.06; 95 percent confidence interval, 1.05 to 1.08; P < 0.001).

"In this growing population of patients, LV dyssynchrony was an independent predictor of adverse outcomes and provided incremental prognostic value over known risk factors for the prediction of long-term outcomes. Therefore, LV dyssynchrony may be useful in daily clinical practice to improve risk stratification and therapeutic management of post-AMI patients," the authors write.

Several authors disclosed financial ties to the pharmaceutical and diagnostic imaging industries.

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