Post-systolic shortening predicts heart failure following acute coronary syndrome.

BACKGROUND: Post-systolic shortening (PSS) is a novel echocardiographic marker of myocardial dysfunction. Our objective was to assess the prognostic value of PSS in patients following acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). METHODS: A total of 428 patients hospitalized for ACS (mean age 64 ±â€¯12 years, male 73%) underwent speckle tracking echocardiography following treatment with PCI (median 2 days). The individual endpoints were heart failure (HF), myocardial infarction (MI) and all-cause death. We excluded known HF. Presence of PSS was defined as post-systolic displacement ≥20% of maximum strain in one cardiac cycle. The post-systolic index (PSI) was defined as (100 × [maximum-strain cardiac cycle - peak-systolic strain])/(maximum-strain cardiac cycle)]. RESULTS: During median follow-up of 3.7 years (IQR 0.3, 5.2), 155 patients (36%) experienced HF, 52 (12%) had MI and 87 (20%) died from all causes. Patients experiencing HF had more walls displaying PSS (3.2 vs. 1.9 walls) and higher PSI (22% vs. 12%) (P < 0.001 both). In Cox proportional hazards models adjusted for baseline characteristics, invasive and echocardiographic measurements, the risk of HF increased incrementally with increasing number of walls with PSS (HR 1.28 95%CI 1.12-1.46, P < 0.001 per 1 increase in walls with PSS). The PSI remained an independent predictor of HF after adjustment (HR 1.61 95%CI 1.21-2.12, P = 0.001 per 1% increase). In the same adjusted models, MI and all-cause death were not significantly associated with PSS. CONCLUSION: Presence of PSS provides novel and independent prognostic information regarding the risk of future HF in patients with ACS following PCI.

Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction.

Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1-3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.