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Background: Right ventricular (RV) systolic function in patients admitted with ST-segment elevation myocardial infarction (STEMI) with chronic obstructive pulmonary disease (COPD) and its impact on prognosis have not been characterized. The present study aims to compare the prevalence of RV systolic dysfunction in COPD versus non-COPD patients with STEMI and evaluate the prognostic implications.Methods: One hundred seventeen STEMI patients with COPD with transthoracic echocardiography performed within 48 hours of admission were retrospectively selected. Matched on age, gender, and infarct size (determined by cardiac biomarkers and left ventricular ejection fraction [LVEF]), 207 non-COPD patients were selected. RV dysfunction was defined based on tricuspid annular plane systolic excursion -20%. Patients were followed for the occurrence of all-cause mortality.Results: RV assessment was feasible in 112 COPD and 199 non-COPD patients (mean age, 69 +/- 10; 74% male; mean, LVEF 47% +/- 8%). Patients with COPD had significantly lower RV FAC (38% +/- 11% vs 40% +/- 9%; P = .04), equal TAPSE and S' (17.9 +/- 3.7 vs 18.1 +/- 3.8 mm, P = .72; and 8.4 +/- 2.2 vs 8.5 +/- 2.2 cm/sec, P = .605, respectively) and more impaired RV FWSL (-21.1% +/- 6.6% vs -23.4% +/- 6.5%, P = .005), compared with patients without COPD. RV dysfunction was more prevalent in patients with COPD, particularly when assessed with RV FWSL (46% vs 32%; P = .021). During a median followup of 30 (interquartile range 1.5-44) months, 49 patients died (16%). Multivariate models stratified for COPD status showed that RV FWS >-20% was independently associated with 5-year all-cause mortality (hazard ratio, 2.05; 95% CI, 1.12-3.76; P = .020), after adjusting for age, diabetes, peak troponin level, and LVEF. Interestingly, RV FAC < 35%, S'< 6 cm/sec, and TAPSE < 17 mm were not independently associated with survival.Conclusion: In a STEMI population with relatively preserved LVEF, COPD patients had significantly worse RV FWSL compared with patients without COPD. Moreover, RV FWSL > -20% was independently associated with worse survival. In contrast, conventional parameters were not associated with survival.

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of mortality after acute ST-segment elevation myocardial infarction (STEMI). We compared STEMI patients with versus without COPD in terms of infarct size and left ventricular (LV) systolic function using advanced 2-dimensional speckle tracking echocardiography. Of 1,750 patients with STEMI (mean age 61 ± 12 years, 76% male), 133 (7.6%) had COPD. With transthoracic echocardiography, left ventricular ejection fraction (LVEF) and wall motion score index were measured. Infarct size was assessed using biomarkers (creatine kinase and troponin T). LV global longitudinal strain (GLS), reflecting active LV myocardial deformation, was measured with 2-dimensional speckle tracking echocardiography to estimate LV systolic function and infarct size. STEMI patients with COPD were significantly older, more likely to be former smokers, and had worse renal function compared with patients without COPD. There were no differences in infarct size based on peak levels of creatine kinase (1315 [613 to 2181] vs 1477 [682 to 3047] U/l, p = 0.106) and troponin T (3.3 [1.4 to 7.3] vs 3.9 [1.5 to 7.8] µg/l, p = 0.489). Left ventricular ejection fraction (46% vs 47%, p = 0.591) and wall motion score index (1.38 [1.25 to 1.66] vs 1.38 [1.19 to 1.69], p = 0.690) were comparable. In contrast, LV GLS was significantly more impaired in patients with COPD compared with patients without COPD (-13.9 ± 3.0% vs -14.7 ± 3.9%, p = 0.034). In conclusion, despite comparable myocardial infarct size and LV systolic function as assessed with biomarkers and conventional echocardiography, patients with COPD exhibit more impaired LV GLS on advanced echocardiography than patients without COPD, suggesting a greater functional impairment at an early stage after STEMI.

Accurate predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in hypertrophic cardiomyopathy (HCM) patients are lacking. Both left atrial volume index (LAVI) and global longitudinal strain (GLS) have been proposed as prognostic markers in HCM patients. The specific value of LAVI and GLS to predict appropriate ICD therapy in high-risk HCM patients was studied. LAVI and 2-dimensional speckle tracking-derived GLS were assessed in 92 HCM patients undergoing ICD implantation (69 % men, mean age 50 ± 14 years). During long-term follow-up, appropriate ICD therapies, defined as antitachycardia pacing and/or shock for ventricular arrhythmia, were recorded. Appropriate ICD therapy occurred in 21 patients (23 %) during a median follow-up of 4.7 (2.2-8.2) years. Multivariate analysis revealed LAVI (p = 0.03) and GLS (p = 0.04) to be independent predictors of appropriate ICD therapy. Both LAVI and GLS showed higher accuracy to predict appropriate ICD therapy compared to presence of ≥1 conventional sudden cardiac death (SCD) risk factor(s) [area under the curve 0.76 (95 % CI 0.65-0.87) and 0.65 (95 % CI 0.54-0.77) versus 0.52 (95 % CI 0.43-0.58) respectively, p < 0.001]. No patient with both LAVI

66 3D speckle-tracking echocardiography in acute myocardial infarction: relationship between contrast-enhanced magnetic resonance imaging and myocardial deformation {#article-title-2} Speckle analysis of 3D echocardiography improves information on left ventricle (LV) segmental and global deformation by avoiding loss of speckles as it is the case in monoplane 2D analysis. Our goal was to evaluate the accuracy of 3D deformation parameters to detect myocardial delayed enhancement (MDE) transmural extent by cardiac magnetic resonance imaging (CMR) in myocardial infarction (MI). Methods: We included 72 patients (57.3±12.4yo) with first acute MI who underwent within 3 days following revascularization both CMR (GE 3T) and echocardiography (GE Vivid E9) including a 3D acquisition of full LV volume. Furthermore, 31 normal subjects (56.5±8.2yo) underwent a complete echocardiography. Automated analysis of 3D allowed the calculation of 3D global LV area (3DGAS), longitudinal (3DGLS), circumferential (3DGCS) and radial (3DGRS) strains (S%). Peak systolic 2D and 3D S values from the 17 LV myocardial segments were recorded. For each segment MDE was defined as transmural (MDE>66%), intermediate (33–66%) and subendocardial (