The role of 3D speckle-tracking echocardiography in predicting long-term outcomes after a first myocardial infarction

Abstract

Aim. To determine the role of 3D echocardiography parameters in the prognosis of long-term cardiovascular complications in patients with a first acute myocardial infarction (AMI).Materials and methods. А prospective, single-center, observational study included 46 patients with a first AMI and successful PCI without a history of heart failure (HF) and shortness of breath upon admission. The examination of patients was performed in accordance with the Russian standards of medical care provision. Additionally, 3D echocardiography was performed, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. The main outcomes assessed were hospitalization with HF, sudden cardiac death, and combined endpoint. Median follow-up was 554 days (IQR 550–785).Results. During the follow-up period, 9 hospitalizations with HF, 3 sudden cardiac deaths, and 12 combined endpoints were registered. The effect of 3D echocardiography parameters on the development of sudden cardiac death and combined endpoint has not been revealed. The effect of the studied parameters on the development of HF during the follow-up period that required hospitalization was evaluated. A statistically significant increase in the LV sphericity index was revealed in the group of patients with the registered outcome. We found significant direct correlations of left ventricular volume indices with prescription of diuretics in the post-discharge period; hospitalization with HF in the post-infarction period with the level of NT-pro-BNP, left atrial volume with the duration of index hospitalization, duration of eventless survival with ST elevation. We found a negative correlation of radial strain with prescription of diuretics in the post-discharge period. Predictors of hospitalization with HF in the post-infarction period were identified – parameters of radial strain, area strain, and circumferential strain, which were included in the model for calculating the risk of the outcome under study.Conclusion. In patients with the first AMI in the absence of clinical signs of HF, to calculate the risk of hospitalization with HF within 550 days after MI, it is advisable to take into account the level of radial strain and use a prognostic model (1), including parameters of circumferential and area strain (according to 3D echocardiography data).