Comprehensive Assessment of the Left Ventricular Systolic Function in the Elderly with Acute Myocardial Infarction
Xin Huang1, Yuan Liu2, Bo Guan1
1Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
Insights
Real-time 3D echocardiography and speckle tracking imaging reveal impaired left ventricular systolic function in elderly patients post-myocardial infarction (MI). Function improves over time but remains lower than in healthy controls, with differences between NSTEMI and STEMI.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Elderly patients with non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) often experience impaired left ventricular (LV) systolic function.
- Accurate assessment of LV systolic function is crucial for managing these patients and predicting outcomes.
- Real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI) offer advanced methods for evaluating cardiac mechanics.
Purpose of the Study:
- To evaluate and compare LV systolic function in elderly patients with NSTEMI and STEMI using RT-3DE and STI.
- To assess the recovery of LV systolic function at 1 week and 3 months post-percutaneous coronary intervention (PCI).
Main Methods:
- Eighty patients (40 NSTEMI, 40 STEMI) underwent RT-3DE and STI after PCI.
- LV volumes, ejection fraction (LVEF), longitudinal, radial, and circumferential peak systolic strain (LPSS, RPSS, CPSS), and LV twist were measured.
- Forty healthy elderly individuals served as the control group.
Main Results:
- Both NSTEMI and STEMI patients showed significantly reduced LVEF, strain parameters, and LV twist compared to controls, persisting at 3 months post-PCI.
- NSTEMI patients exhibited better LV systolic function (higher LPSS, CPSS, rotation, and twist) than STEMI patients at both time points.
- RPSS improved significantly in NSTEMI patients after 3 months, surpassing that of STEMI patients.
Conclusions:
- RT-3DE and STI are sensitive tools for detecting and quantifying LV systolic dysfunction in elderly patients following NSTEMI and STEMI.
- These imaging modalities can differentiate the severity of systolic impairment between NSTEMI and STEMI, even after revascularization.
- LV systolic function remains compromised long-term in post-MI patients, highlighting the need for continued monitoring and management.
Aim:
To evaluate the left ventricular (LV) systolic function in elderly with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI).
Methods:
Forty NSTEMI and forty STEMI patients after undergoing percutaneous coronary artery intervention (PCI) were enrolled. The myocardial segments were supplied by the infarct-related artery (Myo-IRA) which were indicated by the selective coronary arteriography (SCA). The LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV) and ejection fraction (LVEF) were acquired by 4D LV Volume Tom Tec. LV longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) of Myo-IRA segments, LV rotational peak degree in the base (rot-base) and in the apex (rot-apex), and twist were acquired by strain analysis software. Forty older healthy individuals were included as normal controls.
Results:
The LVEF of the NSTEMI and STEMI patients at 1 week after PCI were significantly lower (P<0.05), then, this parameter was improved in both groups after 3 months, but was still significantly lower than that of the controls (P<0.05). The LPSS, RPSS, CPSS of the Myo-IRA segments, rot-Base, rot-Apex and twist in both groups were significantly lower than those in the controls. The LPSS and CPSS of the Myo-IRA segments, rot-Base, rot-Apex and twist in NSTEMI patients were obviously higher than those in STEMI patients in 1 week and 3 months after PCI (P<0.05). After 3 months, the RPSS of NSTEMI patients was improved notably and was obviously higher than that of STEMI patients (P<0.05). All these values in STEMI and NSTEMI patients were improved after 3 months, apart from LPSS in STEMI patients (P>0.05), but were still significantly lower than those in the controls (P<0.05).
Conclusion:
RT-3DE and STI can sensitively assess LV systolic function with different extents of transmural damage.
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