Value of echocardiographic markers in prediction of major adverse cardiac events in patients after ST-elevation myocardial infarction

Abstract Despite of current standard of care treatment, the period after acute ST elevation myocardial infarction (STEMI) is associated with high cardiovascular (CV) risk, with high rates of major adverse cardiac events such as newly diagnosed heart failure (HF), recurrent myocardial infarction, life-threatening arrhythmias, conduction disturbances and cardiovascular death. New markers and their combination is actual in MACE prediction. Objective The aim of the study was to assess echocardiographic markers with speckle-tracking echocardiography markers as early predictors of MACE in patients after STEMI after 12 months follow-up period. Materials and Methods A total of 128 patients after STEMI with successfull percutaneous coronary intervention (PCI) with TIMI III were included in the study. Clinical, hemodynamic, EKG, 2-dimensional transthoracic echocardiography, Doppler and speckle-tracking echocardiography (left ventricular mechanical dispersion (LVMD) and global longitudinal strain (LVGLS)) were measured in the acute period and after 12 months to assess risk of MACE in patients after STEMI. The levels of biomarkers were measured at baseline. PCI was successful and all enrolled patients had TIMI >2. End points such as MACE (newly diagnosed HF, recurrent myocardial infarction, arrhythmias and conduction disturbances composite of cardiovascular death,) were estimated within 12 months. Results 128 patients after STEMI with successfull PCI with TIMI III were enrolled in the study. Patients after STEMI were divided into two cohorts according on the presence of MACE after 1 year. The Cox-analyses indicated that LVGLS and LVMD were independent factors in risk prediction of MACE for patients with STEMI (p=0,0006 and p<0,0001 respectively). Uni- and multivariate logistic regression analysis were performed to assess value of markers on MACE prognosis. The optimal combination of different data for risk prognosis of adverse events was found in patients with STEMI after 1-year follow-up period, among them were LVMD, LVGLS, left atrium volume index (LAVI), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LV EF). The most independent factors were LVMD, LVGLS. Conclusion Our study demonstrated that combination of echocardiographic markers such as left ventricular mechanical dispersion, global longitudinal strain, left ventricular end diastolic diameter, left ventricular ejection fraction) left atrium volume index might be useful in prognosis of MACE in 12 months follow-up period in patients after STEMI with successful PCI. LVGLS and LVMD were independent factors in risk stratification of MACE for patients with STEMI.