Key result
A PWV/GLS ratio >0.70 assessed 1 month after myocardial infarction was independently associated with an increased risk of major cardiovascular events.
Why the study?
The clinical significance and feasibility of non-invasive ventricular-arterial coupling parameters remained uncertain in stable post-myocardial infarction patients with LVEF >=40%.
Do ventricular-arterial coupling parameters (PWV/GLS and Ea/Ees) predict MACE in stable patients with LVEF ≥40% following MI?
Cohort (n=374)
Do ventricular-arterial coupling parameters (PWV/GLS and Ea/Ees) predict MACE in stable patients with LVEF ≥40% following MI?
Answers are grounded in this paper and cite their sources.
The PWV/GLS ratio assessed 1 month after MI provides independent prognostic value for predicting MACE in patients with LVEF ≥40%, offering additional risk stratification beyond conventional parameters.
AIMS: The clinical significance and feasibility of the recently described non-invasive parameters exploring ventricular-arterial coupling (VAC) remain uncertain. This study aimed to assess VAC parameters for prognostic stratification in stable patients with left ventricular ejection fraction (LVEF) ≥40% following myocardial infarction (MI). METHODS AND RESULTS: Between 2018 and 2021, patients with LVEF ≥40% were evaluated 1 month following MI using transthoracic echocardiography (TTE) and arterial tonometry at rest and after a handgrip test. VAC was studied via the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees) and between pulse wave velocity (PWV) and global longitudinal strain (GLS). Patients were followed for major adverse cardiovascular events (MACE): all-cause death, acute heart failure, stroke, AMI, and urgent cardiovascular hospitalization. Among the 374 patients included, Ea/Ees and PWV/GLS were obtained at rest for 354 (95%) and 253 patients (68%), respectively. Isometric exercise was workable in 335 patients (85%). During a median follow-up of 32 months (interquartile range: 16-42), 41 (11%) MACE occurred. Patients presenting MACE were significantly older and had a higher prevalence of peripheral arterial disease, lower GLS, higher Ea, PWV, and PWV/GLS ratio. The Ea/Ees ratio and standard TTE parameters during isometric exercise were not associated with MACE. After adjustment, the PWV/GLS ratio was the only VAC parameter independently associated with outcome. Receiver operating characteristic curve analysis identified a PWV/GLS ratio >0.70 (Youden's index = 0.37) as the best threshold to identify patients developing MACE: hazard ratio (95% confidence interval) = 2.2 (1.14-4.27), P = 0.02. CONCLUSION: The PWV/GLS ratio, assessed 1 month after MI, identifies a group of patients at higher risk of MACE providing additional value on top of conventional non-invasive parameters.
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Aghezzaf et al. (2023) conducted a cohort in Myocardial infarction (n=374). PWV/GLS ratio >0.70 vs. PWV/GLS ratio ≤0.70 was evaluated on Major adverse cardiovascular events (MACE): all-cause death, acute heart failure, stroke, AMI, and urgent cardiovascular hospitalization (HR 2.2, 95% CI 1.14-4.27, p=0.02). A PWV/GLS ratio >0.70 assessed 1 month after myocardial infarction was independently associated with an increased risk of major cardiovascular events.
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