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Influence of the cardio-ankle vascular index on chronic-phase left ventricular dysfunction after ST-segment elevation
Jin Kirigaya1, Noriaki Iwahashi1, Takeru Abe1,2
1Division of Cardiology, Yokohama City University Medical Center.
Insights
Arterial stiffness, measured by cardio-ankle vascular index (CAVI), predicts long-term left ventricular dysfunction after ST-segment elevation myocardial infarction (STEMI). Early CAVI assessment aids in evaluating chronic-phase left ventricular function post-STEMI.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Clinical Cardiology
Background:
- Arterial stiffness is an emerging cardiovascular risk factor.
- Left ventricular dysfunction is a common complication after ST-segment elevation myocardial infarction (STEMI).
- The cardio-ankle vascular index (CAVI) is a measure of arterial stiffness.
Purpose of the Study:
- To investigate the association between arterial stiffness (CAVI) and chronic-phase left ventricular dysfunction in STEMI patients.
- To determine if CAVI can predict long-term left ventricular global longitudinal strain (LV-GLS) after STEMI.
- To assess the added predictive value of combining CAVI with infarct size markers for LV-GLS.
Main Methods:
- 208 STEMI patients underwent CAVI measurement and echocardiography (baseline and 7-month follow-up).
- Left ventricular global longitudinal strain (LV-GLS) was assessed to evaluate left ventricular function.
- Cardiac magnetic resonance (CMR) and peak creatine kinase-myocardial band (CK-MB) were used to estimate infarct size.
Main Results:
- Patients with high CAVI showed significantly worse LV-GLS at 7 months compared to those with low CAVI.
- CAVI was identified as an independent predictor of chronic-phase LV-GLS.
- Combining CAVI with infarct size markers (CK-MB or CMR-late gadolinium enhancement) improved the prediction of LV-GLS.
Conclusions:
- Early arterial stiffness assessment by CAVI is significantly associated with chronic-phase left ventricular dysfunction after STEMI.
- CAVI measurement provides valuable prognostic information for left ventricular function post-myocardial infarction.
- Integrating CAVI with infarct size assessment enhances the prediction of long-term left ventricular dysfunction.
Objective:
This study aimed to investigate the possible influence of arterial stiffness assessed by the cardio-ankle vascular index (CAVI) on chronic-phase left ventricular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
A total of 208 consecutive patients with first STEMI (age, 64 ± 11 years; 86% men) who underwent reperfusion therapy within 12 h of onset were enrolled. We analysed arterial stiffness by measuring CAVI in a stable phase after admission and performed two-dimensional echocardiography at baseline and 7 months' follow-up. Subsequently, we assessed left ventricular global longitudinal strain (LV-GLS) to evaluate left ventricular function. A total of 158 (75.9%) patients underwent baseline cardiac magnetic resonance (CMR). We estimated left ventricular infarct size by measuring peak levels of creatine kinase-myocardial band (CK-MB), and CMR-late gadolinium enhancement (LGE).
Results:
On the basis of the median CAVI value, the patients were allocated into high CAVI (CAVI ≥ 8.575) and low CAVI (CAVI < 8.575) groups. The groups showed no statistically significant differences in LV-GLS at baseline (-13.5% ± 3.1 vs. -13.9% ± 2.7%, P = 0.324). However, LV-GLS was significantly worse in the high CAVI group than in the low-CAVI group at 7 months (-14.0% ± 2.9 vs. -15.6% ± 3.0%, P < 0.001). Stratified by CAVI and peak CK-MB or LGE, the four groups showed significant differences in LV-GLS at 7 months after STEMI (both P < 0.001). Multivariate linear regression analysis with the forced inclusion model showed that CAVI was an independent predictor of LV-GLS at 7 months ( P = 0.015).
Conclusion:
CAVI early after STEMI onset was significantly associated with chronic-phase LV-GLS. In addition, combining CAVI with CK-MB or LGE improves its predictive ability for evaluation of chronic-phase LV-GLS. Thus, the arterial stiffness assessment by CAVI was an important factor related to chronic-phase left ventricular dysfunction after the first STEMI.
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