1. Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both.
- Author
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Shin SH, Hung CL, Uno H, Hassanein AH, Verma A, Bourgoun M, Køber L, Ghali JK, Velazquez EJ, Califf RM, Pfeffer MA, and Solomon SD
- Subjects
- Aged, Analog-Digital Conversion, Angiotensin II Type 1 Receptor Blockers therapeutic use, Death, Disease Progression, Female, Follow-Up Studies, Heart Failure drug therapy, Heart Failure etiology, Heart Failure mortality, Heart Failure physiopathology, Humans, Male, Middle Aged, Motion, Prognosis, Proportional Hazards Models, Stress, Mechanical, Tetrazoles therapeutic use, Ultrasonography, Valine analogs & derivatives, Valine therapeutic use, Valsartan, Ventricular Dysfunction, Left drug therapy, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Video Recording, Heart Failure diagnostic imaging, Myocardial Contraction, Myocardial Infarction complications, Ventricular Dysfunction, Left diagnostic imaging
- Abstract
Background: Mechanical dyssynchrony is considered an independent predictor for adverse cardiovascular outcomes in patients with heart failure. However, its importance as a risk factor after myocardial infarction is not well defined., Methods and Results: We examined the influence of mechanical dyssynchrony on outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiography study. B-mode speckle tracking with velocity vector imaging was used to assess ventricular synchrony in 381 patients who had image quality sufficient for analysis. Time to regional peak velocity and time to strain rate were measured among 12 left ventricular segments from the apical 4- and 2- chamber views, and the SDs between all 12 segments were used as a measure of dyssynchrony. The relationships between the SD of time to regional peak velocity and strain rate and clinical outcome of death or heart failure were assessed. In a multivariate Cox model adjusted for clinical and echocardiographic variables, the SD of time to peak velocity (hazard ratio per 10 ms, 1.10; 95% confidence interval, 1.02 to 1.18; P=0.010) and the SD of time to strain rate (hazard ratio per 10 ms, 1.16; 95% confidence interval, 1.06 to 1.27; P=0.001) were independent predictors of death or heart failure., Conclusions: Left ventricular dyssynchrony is independently associated with increased risk of death or heart failure after myocardial infarction, suggesting that contractile pattern may play a role in post-myocardial infarction prognosis.
- Published
- 2010
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