Abstract 364: Time Course and Determinants of Left Ventricular Function Recovery After Acute Myocardial Infarction
Background The prognostic value of left ventricular (LV) function after acute myocardial infarction (AMI) has been extensively studied. However, the time course of LV function has not been completely elucidated. The purpose of the present study was to evaluate the time course of LV systolic function quantified with global longitudinal peak systolic strain (GLPSS) during 1 year follow-up after AMI. In addition, the degree of recovery of LV function was assessed and predictors of the recovery of LV function were identified.
Methods Patients admitted with AMI treated with primary percutaneous coronary intervention were evaluated. 2D echocardiography was performed at baseline within 48 hours after admission and during follow-up at 3, 6 and 12 months. Baseline echocardiography was used to assess LV function with traditional parameters and GLPSS. During follow-up GLPSS was re-assessed at 3, 6 and 12 months. Patients were divided into the following subgroups based on the increase in GLPSS during follow-up: improvers (patients with ≥10% increase of GLPSS) and non-improvers (patients without ≥10% increase of GLPSS).
Results A total of 313 patients were evaluated. Mean age was 60±12 years and most patients were men (243 patients, 78%). Mean LV ejection fraction was 46±8%. During follow-up mean GLPSS increased from −13.8±3.0% to −16.0±3.4% at 3 months (p <0.0001), −16.3±3.6% at 6 months and −16.8±3.9% at 12 months (p <0.0001 vs. 3 months). Improvement of LV function (≥10% increase of GLPSS) was observed in 78% of the patients. Majority of the patients (58%) showed improvement at 3 months. Peak cardiac troponin T level (HR 0.77, 95%CI 0.71 – 0.83), deceleration time (HR 1.01, 95%CI 1.00 – 1.01) and baseline GLPSS (HR 1.25, 95%CI 1.07 – 1.45) were independent predictors of improvement of LV function. Baseline GLPSS appeared to be superior to LV end-systolic volume and wall motion score index in the prediction of recovery of LV function.
Conclusions The majority of patients after AMI demonstrated improvement of LV function during 1 year follow-up. Peak cardiac troponin T level, deceleration time and GLPSS were identified as early, independent predictors of recovery of LV function. Quantification of GLPSS may be of important value in the risk stratification of patients after AMI.