Abstract 1876: Incremental Value of Echocardiographic Assessment Beyond Clinical Evaluation for Prediction of Death and Development of Heart Failure After Myocardial Infarction in Patients with Left Ventricular Dysfunction, Heart Failure, or Both
Background: Echocardiographic (echo) measurements of left ventricular (LV) function, predominantly LV ejection fraction (LVEF), have been used to define risk in patients following myocardial infarction (MI). The extent to which echo assessment beyond LV function provides incremental prognostic value over clinical variables in survivors of high-risk MI has not been well defined.
Methods: Predictors of death and development of heart failure were assessed in 603 patients from the VALIANT echo substudy. We used multivariable proportional-hazards models to assess the individual predictive value of echo measures, including LV end-diastolic volume (EDV), LV mass index (LVMI), LVEF, left atrial volume index (LAVi), right ventricular fractional area change (RVFAC), and mitral regurgitation (MR). We adjusted for the 11 clinical variables found previously to be most associated with outcomes in the full VALIANT cohort. ROC curves obtained via binary response regression were used to assess the incremental predictive value of echocardiography.
Results: Each echo measure was independently associated with outcome (all P<0.002): LVMI (HR 1.3/10 gm/m2 increase), LVEF (HR 1.3/5% decrease), LAVi (HR 1.04/mL/m2 increase), MR (HR 1.03/1% increase), RVFAC (HR 1.3/5% decrease), and LVEDV (HR 1.1/10 mL increase). While LVEF alone added minimal prognostic value to the clinical assessment, additional echo assessments improved predictive value significantly (Figure⇓), increasing the c-statistic from 0.74 to 0.84 (P<0.001).
Conclusion: Echo measures of cardiac structure and function provide important prognostic information beyond the clinical assessment and LVEF.