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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Feasibility and prognostic significance of ventricular-arterial coupling after myocardial infarction: the RIGID-MI
Samy Aghezzaf1, Augustin Coisne1,2, Christophe Bauters3
1Inserm, CHU Lille, Institut Pasteur de Lille, University Lille, U1011-EGID, F-59000 Lille, France.
Insights
The pulse wave velocity to global longitudinal strain ratio (PWV/GLS) effectively identifies patients at higher risk of major adverse cardiovascular events (MACE) after myocardial infarction (MI). This non-invasive measure offers valuable prognostic information beyond standard assessments.
Area of Science:
- Cardiovascular Physiology
- Non-invasive Cardiac Assessment
- Prognostic Biomarkers
Background:
- Ventricular-arterial coupling (VAC) parameters are novel non-invasive tools for assessing cardiovascular health.
- Their clinical utility and prognostic value, particularly in patients post-myocardial infarction (MI) with preserved ejection fraction, require further investigation.
- Accurate risk stratification is crucial for managing patients following MI.
Purpose of the Study:
- To evaluate the prognostic significance of VAC parameters in stable patients with left ventricular ejection fraction (LVEF) ≥40% after MI.
- To assess the feasibility of measuring VAC parameters using transthoracic echocardiography (TTE) and arterial tonometry.
- To determine if VAC parameters can improve risk stratification for major adverse cardiovascular events (MACE).
Main Methods:
- A cohort of 374 patients with LVEF ≥40% were assessed 1 month post-MI.
- Ventricular-arterial coupling (VAC) was evaluated using the ratio of arterial elastance (Ea) to end-systolic LV elastance (Ees) and pulse wave velocity (PWV) to global longitudinal strain (GLS).
- Patients were followed for MACE, including death, heart failure, stroke, and hospitalization.
Main Results:
- The PWV/GLS ratio, but not the Ea/Ees ratio or exercise TTE parameters, was independently associated with MACE after adjustment.
- A PWV/GLS ratio >0.70 was identified as the optimal threshold for predicting MACE (HR 2.2, P=0.02).
- Patients with MACE were older, had higher PWV/GLS ratios, and lower global longitudinal strain (GLS).
Conclusions:
- The PWV/GLS ratio, assessed one month after myocardial infarction (MI), is a valuable non-invasive parameter for identifying patients at higher risk of MACE.
- This ratio provides prognostic information that complements conventional non-invasive assessments.
- Further research can explore the integration of PWV/GLS into routine clinical practice for post-MI risk stratification.
Aims:
The clinical significance and feasibility of the recently described non-invasive parameters exploring ventricular-arterial coupling (VAC) remain uncertain. This study aimed to assess VAC parameters for prognostic stratification in stable patients with left ventricular ejection fraction (LVEF) ≥40% following myocardial infarction (MI).
Methods And Results:
Between 2018 and 2021, patients with LVEF ≥40% were evaluated 1 month following MI using transthoracic echocardiography (TTE) and arterial tonometry at rest and after a handgrip test. VAC was studied via the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees) and between pulse wave velocity (PWV) and global longitudinal strain (GLS). Patients were followed for major adverse cardiovascular events (MACE): all-cause death, acute heart failure, stroke, AMI, and urgent cardiovascular hospitalization. Among the 374 patients included, Ea/Ees and PWV/GLS were obtained at rest for 354 (95%) and 253 patients (68%), respectively. Isometric exercise was workable in 335 patients (85%). During a median follow-up of 32 months (interquartile range: 16-42), 41 (11%) MACE occurred. Patients presenting MACE were significantly older and had a higher prevalence of peripheral arterial disease, lower GLS, higher Ea, PWV, and PWV/GLS ratio. The Ea/Ees ratio and standard TTE parameters during isometric exercise were not associated with MACE. After adjustment, the PWV/GLS ratio was the only VAC parameter independently associated with outcome. Receiver operating characteristic curve analysis identified a PWV/GLS ratio >0.70 (Youden's index = 0.37) as the best threshold to identify patients developing MACE: hazard ratio (95% confidence interval) = 2.2 (1.14-4.27), P = 0.02.
Conclusion:
The PWV/GLS ratio, assessed 1 month after MI, identifies a group of patients at higher risk of MACE providing additional value on top of conventional non-invasive parameters.
