Abstract 14807: Tissue Doppler Imaging Predicts Long Term Outcome in Patients with ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Abstract

Purpose: To investigate the prognostic value of Tissue Doppler Imaging (TDI) after an ST-elevation myocardial infarction (STEMI).

Method: In total, 391 patients were admitted with a STEMI and treated with primary Percutaneous Coronary Intervention. Echocardiography was performed median 2 days after the STEMI. Longitudinal systolic (s'), early diastolic (e') and late diastolic (a') myocardial velocities were measured by color TDI at 6 mitral annular sites and averaged to provide global estimates. Treatment effect was assessed in relation to death (n=29), hospitalization with heart failure (CHF, n=49) and new myocardial infarction (MI, n=25). Follow-up was median 25 months.

Results: Using the mean value of global s’, e’ and a’ as cutoff, the population was stratified according to high or low s’, e’ and a’ (see table). Patients with low global s’ or e’ had more than two times the risk of an adverse outcome (death, CHF or re-MI, n = 89) than patients with high global s’ or e’, respectively. Patients who had both low values of s’ and e’ had more than three times the risk of an adverse outcome than patients with both high s’ and e’. Furthermore, patients who, in addition to a low global s’ and e’, also had a low a’ had an even worse prognosis (see table). After adjustment for age, gender, peak troponins, previous MI, ejection fraction, left ventricular mass index and left ventricular dimension in a multivariate Cox proportional hazard model, patients who had global s’ and e’ or global s’, e’ and a’ below the mean remained in significantly higher risk of reaching the combined endpoint than patients without s’ and e’ below the mean (hazard ratio of 1.70 (1.03-2.79); p=0.038).

Conclusion: A pattern of low systolic and low early diastolic global TDI velocities seems to be the paramount marker of an adverse prognosis for patients with STEMI, which is exacerbated by a low late diastolic velocity. The TDI velocities should be evaluated together as they interact on prognosis.