Abstract 547: Novel Diastolic Indices Provide Incremental Prognostic Information on the Clinical Outcome in Patients With First ST-Elevation Myocardial Infarction
Objectives: The study examined prognostic value of the novel diastolic indices in acute ST-elevation myocardial infarction (STEMI) patients.
Background: Prognostic value of recently developed novel diastolic indices by 2-dimensional speckle tracking (2DST) in acute STEMI is unknown.
Methods: Echocardiograms were performed within 48 hours of admission in 371 consecutive, first STEMI patients (age 59.7±11.6 years). Indices of diastolic function including strain rate during isovolumic relaxation (SRIVR), early diastolic strain rate (SRE) and diastolic strain at peak transmitral E wave (DSE) by 2DST were obtained from 3 apical views. Mean Em from 4 basal segments by color-coded tissue Doppler imaging was measured. Indices of diastolic filling including E/SRIVR, E/SRE, E/DSE, and E/Em were calculated.
Results: Primary endpoint (composite of death, heart failure hospitalization, re-infarction and repeat revascularization) occurred in 84 patients (22.6%) during mean follow-up of 16.8±11.9 months. Mean SRIVR (p<0.001), multivessel disease (p<0.001), TIMI flow 0 –1 post-percutaneous coronary intervention (PCI) (p = 0.004) and LVEF (p = 0.008) were independent predictors of combined endpoint on Cox regression analysis. Mean SRIVR showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p < 0.001).
Conclusion: After STEMI, mean SRIVR, LVEF, number of stenosed vessels and TIMI flow 0 –1 post-PCI were independent predictors of outcome. Mean SRIVR was the only diastolic index that provided incremental prognostic information over LVEF and may be useful in identifying high risk STEMI patients.