Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction
Jacob E Møller1, Graham S Hillis, Jae K Oh
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Wall motion score index (WMSI) better predicts mortality and heart failure hospitalizations after myocardial infarction than left ventricular ejection fraction (LVEF). WMSI offers greater prognostic insight in large patient populations.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Prognostic value of regional systolic function (WMSI) vs. global function (LVEF) post-myocardial infarction (MI) is understudied in large cohorts.
- Assessing cardiac function post-MI is crucial for patient outcomes.
Purpose of the Study:
- To compare the prognostic importance of WMSI versus LVEF in predicting mortality and heart failure hospitalization after acute MI.
- To determine which measure of cardiac function provides superior prognostic information.
Main Methods:
- Echocardiograms assessing WMSI and LVEF were performed in 767 acute MI patients.
- Patients were followed for a median of 19 months for mortality and heart failure hospitalization.
- Cox proportional hazards models were used to analyze prognostic predictors.
Main Results:
- Both WMSI and LVEF predicted all-cause mortality and heart failure hospitalization in univariate analysis.
- WMSI independently predicted death (HR 1.15 per 0.2-unit increase) and heart failure hospitalization (HR 1.21 per 0.2-unit increase).
- LVEF did not provide additional prognostic information when WMSI was included in the model.
Conclusions:
- WMSI is a more powerful independent predictor of adverse outcomes post-MI than LVEF.
- Regional systolic function assessment via WMSI offers greater prognostic value than global function (LVEF).
Background:
The prognostic importance of regional systolic function, as assessed by wall motion score index (WMSI), compared with global function, as assessed by left ventricular ejection fraction (LVEF), has not been assessed in large populations after acute myocardial infarction.
Methods:
Echocardiograms, including the assessment of WMSI and LVEF, were performed in 767 patients with acute myocardial infarction at a median of 1 day (25th and 75th percentiles 0-2 days) after admission. Patients were followed for a median of 19 months (range 12-28 months). Cox proportional hazards models were constructed for the primary study end point (all-cause mortality) and for a secondary end point (hospitalization for congestive heart failure).
Results:
During follow-up (median 40 months; range 32-50 months), 216 patients died and 54 patients were hospitalized for congestive heart failure. By univariate analysis, both LVEF (P < .0001) and WMSI (P < .0001) were powerful predictors of all-cause mortality. By a forward conditional Cox model, WMSI proved to be an independent predictor of death (hazard ratio 1.15 per 0.2-unit increase, 95% CI 1.10-1.21, P < .0001). When WMSI was included in the model, LVEF did not provide additional prognostic information (P = .77). Wall motion score index also proved to be an independent predictor of hospitalization for congestive heart failure (hazard ratio 1.21 per 0.2-unit increase, 95% CI 1.07-1.37, P = .002), whereas LVEF did not (P = .56).
Conclusion:
Both LVEF and WMSI provide powerful prognostic information after acute myocardial infarction; however, the predictive power of WMSI is greater.
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