Repeated echocardiography after first ever ST-segment elevation myocardial infarction treated with primary
Helle Søholm1, Jacob Lønborg2, Mads J Andersen2
1Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark helle.soholm@gmail.com.
Insights
Repeated echocardiography is crucial for assessing left ventricular (LV) function post-ST-segment elevation myocardial infarction (STEMI), especially for patients with initial dysfunction. Re-evaluation may not be necessary for those with preserved LV ejection fraction (LVEF) at baseline.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- Left ventricular (LV) function assessment is critical post-ST-segment elevation myocardial infarction (STEMI).
- Contemporary STEMI management involves primary percutaneous coronary intervention (PCI).
- The necessity of serial LV function imaging after STEMI requires further investigation.
Purpose of the Study:
- To evaluate changes in LV function using echocardiography and cardiac magnetic resonance (CMR) in STEMI patients.
- To determine if repeated imaging is necessary for monitoring LV function recovery.
- To correlate myocardial salvage with baseline LV ejection fraction (LVEF).
Main Methods:
- Prospective study of first STEMI patients treated with primary PCI.
- 2D-echocardiography and CMR imaging performed at baseline (<72h) and 3-month follow-up.
- Assessment of LVEF, systolic dysfunction severity, and myocardial salvage index.
Main Results:
- 35% had preserved LVEF, 55% mild/moderate, and 10% severe dysfunction at baseline.
- 64% of patients showed improved systolic function at follow-up; 79% with severe baseline dysfunction improved.
- 11% experienced deterioration, but no patient declined from preserved to severe dysfunction; lower myocardial salvage index correlated with declining LVEF.
Conclusions:
- Most STEMI patients with initial severe LV dysfunction show significant improvement at 3 months.
- Repeated LV function assessment is important for patients with mild/moderate or severe dysfunction post-STEMI.
- Re-assessment may be unnecessary for STEMI patients with preserved LVEF at baseline.
Aim:
Changes in left ventricular (LV) function using echocardiography and cardiac magnetic resonance (CMR) imaging were assessed in a contemporary ST-segment elevation myocardial infarction (STEMI) population to assess whether repeated imaging is necessary.
Methods:
In a prospective study patients with first STEMI were treated with primary percutaneous coronary intervention (PCI) and examined with 2D-echocardiography and CMR at baseline (<72 h) and at a three-month follow-up.
Results:
A total of 138 patients were included (60±11 years). Using 2D-echocardiography at baseline preserved left ventricular ejection fraction (LVEF) (>50%) was found in 48 patients (35%), mild/moderate systolic dysfunction (35-50%) in 76 patients (55%) and severe dysfunction (<35%) in 14 patients (10%). Improvement in systolic function group was seen in 58 patients (64%) and 11 patients (79%) with severe systolic dysfunction at baseline were re-classified as having preserved or mild/moderate systolic dysfunction at follow-up. Irrespective of baseline LVEF, deterioration in systolic function group was noted in 14 patients (11%), but no patients declined from preserved to severe systolic dysfunction. The recovered myocardium measured with the myocardial salvage index by CMR was significantly lower with declining LVEF at baseline.
Conclusion:
The majority of patients with severely depressed LVEF immediately after STEMI significantly improved systolic function after three months. This study emphasises the importance of a repeated LV function assessment at follow-up in patients with mild/moderate or severe systolic dysfunction after STEMI, but re-assessment may not be needed in patients with preserved LVEF at baseline.
More Related Videos
11:50High-frequency High-resolution Echocardiography: First Evidence on Non-invasive Repeated Measure of Myocardial Strain, Contractility, and Mitral Regurgitation in the Ischemia-reperfused Murine Heart
Published on: July 9, 2010
08:31A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Coronary Artery Disease V: Interprofessional Care