ST-Segment Elevation Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: Prognostic Implications of Right Ventricular Systolic Dysfunction as Assessed with Two-Dimensional Speckle-Tracking Echocardiography - 03/10/19
Abstract |
Background |
Right ventricular (RV) systolic function in patients admitted with ST-segment elevation myocardial infarction (STEMI) with chronic obstructive pulmonary disease (COPD) and its impact on prognosis have not been characterized. The present study aims to compare the prevalence of RV systolic dysfunction in COPD versus non-COPD patients with STEMI and evaluate the prognostic implications.
Methods |
One hundred seventeen STEMI patients with COPD with transthoracic echocardiography performed within 48 hours of admission were retrospectively selected. Matched on age, gender, and infarct size (determined by cardiac biomarkers and left ventricular ejection fraction [LVEF]), 207 non-COPD patients were selected. RV dysfunction was defined based on tricuspid annular plane systolic excursion <17 mm (TAPSE), tricuspid annular systolic velocity <6 cm/s (S′), RV fractional area change <35% (FAC), and RV longitudinal free wall strain (FWSL) measured with speckle-tracking echocardiography >–20%. Patients were followed for the occurrence of all-cause mortality.
Results |
RV assessment was feasible in 112 COPD and 199 non-COPD patients (mean age, 69 ± 10; 74% male; mean, LVEF 47% ± 8%). Patients with COPD had significantly lower RV FAC (38% ± 11% vs 40% ± 9%; P = .04), equal TAPSE and S′ (17.9 ± 3.7 vs 18.1 ± 3.8 mm, P = .72; and 8.4 ± 2.2 vs 8.5 ± 2.2 cm/sec, P = .605, respectively) and more impaired RV FWSL (–21.1% ± 6.6% vs –23.4% ± 6.5%, P = .005), compared with patients without COPD. RV dysfunction was more prevalent in patients with COPD, particularly when assessed with RV FWSL (46% vs 32%; P = .021). During a median follow-up of 30 (interquartile range 1.5-44) months, 49 patients died (16%). Multivariate models stratified for COPD status showed that RV FWS >–20% was independently associated with 5-year all-cause mortality (hazard ratio, 2.05; 95% CI, 1.12-3.76; P = .020), after adjusting for age, diabetes, peak troponin level, and LVEF. Interestingly, RV FAC < 35%, S′< 6 cm/sec, and TAPSE < 17 mm were not independently associated with survival.
Conclusion |
In a STEMI population with relatively preserved LVEF, COPD patients had significantly worse RV FWSL compared with patients without COPD. Moreover, RV FWSL > –20% was independently associated with worse survival. In contrast, conventional parameters were not associated with survival.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Right ventricular (RV) dysfunction is common after acute myocardial infarction. |
• | Chronic obstructive pulmonary disease (COPD) increases the risk of RV dysfunction. |
• | RV strain is significantly worse in patients with COPD compared to those without. |
• | · Conventional parameters are unable to detect subtle differences in RV function. |
• | RV strain is independently associated with mortality; adjusted for COPD presence. |
Keywords : ST-segment elevation myocardial infarction, Right ventricular dysfunction, Chronic obstructive pulmonary disease, Prognosis
Abbreviations : BSA, CK, COPD, FAC, FWSL, HR, LV, LVEF, MR, RA, RCA, RV, RV EDA, RV ESA, RVOT, SPAP, STE, STEMI, TAPSE, TDI, TR, TTE
Plan
| The Department of Cardiology of the Leiden University Medical Centre received grants from Biotronik, Medtronic, Boston Scientific Corporation, GE Healthcare, and Edwards Lifesciences. V.D. received speaker fees from Abbott Vascular. |
|
| Bijoy K. Khandheria, MD, MBBS, FASE, served as guest editor for this report. |
Vol 32 - N° 10
P. 1277-1285 - octobre 2019 Retour au numéro
Article précédent
- Left Atrial Mechanical Dispersion Assessed by Strain Echocardiography as an Independent Predictor of New-Onset Atrial Fibrillation: A Case-Control Study
- Hiroshi Kawakami, Satish Ramkumar, Mark Nolan, Leah Wright, Hong Yang, Kazuaki Negishi, Thomas H. Marwick
- Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization
- Yuta Torii, Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Yukina Hirata, Rie Amano, Masami Yamao, Robert Zheng, Yoshihito Saijo, Nao Yamada, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?