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Prognosis after acute coronary syndrome in relation with ventricular-arterial coupling and left ventricular strain

Agata Milewska1, Andrzej Minczykowski1, Tomasz Krauze1

  • 1Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.

International Journal of Cardiology
|July 9, 2016
PubMed

Insights

Non-invasive measures of left ventricle (LV) and arterial function, including ventricular-arterial (VA) coupling, predict adverse outcomes in acute coronary syndrome (ACS) patients. These findings hold true independently of LV ejection fraction, offering valuable prognostic insights.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Prognostics

Background:

  • Prognostic value of non-invasive LV and arterial function indices in acute coronary syndrome (ACS) is not well-established.
  • Contemporary ACS treatments necessitate updated prognostic markers.
  • Ventricular-arterial (VA) coupling, LV global longitudinal peak systolic strain (GLPSS), global strain rate (GSR), and end-diastolic volume at end-diastolic pressure 30mmHg (V30) are key indices.

Purpose of the Study:

  • To assess the association of VA coupling, GLPSS, GSR, and V30 with long-term clinical outcomes in ACS patients.
  • To determine if these indices predict adverse events independently of traditional markers like LV ejection fraction.

Main Methods:

  • Echocardiography utilized in 569 ACS patients with >12 months follow-up.
  • Univariate Cox regression models analyzed associations, adjusting for clinical factors including reduced LV ejection fraction (<40%).
  • Combined endpoint: stroke, myocardial infarction, or death.

Main Results:

  • 57 clinical outcomes observed over a median 625-day follow-up.
  • Increased VA coupling (>1.68), V30 (>107mL), GLPSS (>-12.8%), and GSR (>-0.96 1/s) were robustly associated with increased hazard.
  • Hazard ratios ranged from 2.4 to 4.5 for these adverse predictors.

Conclusions:

  • Abnormal non-invasive LV and arterial function indices predict adverse outcomes in contemporary ACS patients.
  • These predictive capabilities are independent of LV ejection fraction.
  • These indices offer valuable prognostic information for ACS management.
Abstract

Keywords:
Acute coronary syndromeEjection fractionGlobal strainPressure–volume relationshipVentricular–arterial coupling

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