scholarly journals Effect of Cardiac Rehabilitation on Left Ventricular Diastolic Function in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 10 (10) ◽  
pp. 2088
Author(s):  
Jae-Hwan Lee ◽  
Jungai Kim ◽  
Byung Joo Sun ◽  
Sung Ju Jee ◽  
Jae-Hyeong Park
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Volume Index ◽  
Prognostic Impact ◽  
Echocardiographic Parameters

Cardiac rehabilitation (CR) improves symptoms and survival in patients with acute myocardial infarction (AMI). We studied the change of diastolic function and its prognostic impact after CR. After reviewing all consecutive AMI patients from January 2012 to October 2015, we analyzed 405 patients (mean, 63.7 ± 11.7 years; 300 males) with baseline and follow-up echocardiographic examinations. We divided them into three groups according to their CR sessions: No-CR group (n = 225), insufficient-CR group (CR < 6 sessions, n = 117) and CR group (CR ≥ 6 sessions, n = 63). We compared echocardiographic parameters of diastolic dysfunction including E/e’ ratio > 14, septal e’ velocity < 7 cm/s, left atrial volume index (LAVI) > 34 mL/m2, and maximal TR velocity > 2.8 m/s. At baseline, there were no significant differences in all echocardiographic parameters among the three groups. At follow-up echocardiographic examination, mitral annular e’ and a’ velocities were higher in the CR group (p = 0.024, and p = 0.009, respectively), and mitral E/e’ ratio was significantly lower (p = 0.009) in the CR group. The total number of echocardiographic parameters of diastolic dysfunction at the baseline echocardiography was similar (1.29 vs. 1.41 vs. 1.52, p = 0.358). However, the CR group showed the lowest number of diastolic parameters at the follow-up echocardiography (1.05 vs. 1.32 vs. 1.50, p = 0.017). There was a significant difference between the No-CR group and CR group (p = 0.021). The presence of CR was a significant determinant of major adverse cardiovascular events in the univariate analysis (HR = 0.606, p = 0.049). However, the significance disappeared in the multivariate analysis (HR = 0.738, p = 0.249). In conclusion, the CR was significantly associated with favorable diastolic function, with the highest mitral e’ and a’ velocity, and the lowest mitral E/e’ ratio and total number of echocardiographic parameters of diastolic dysfunction at the follow-up echocardiographic examinations in AMI patients.

Abstract 18996: Impact of Infarct Size on Left Ventricular Diastolic Function Following Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Andrew Lin ◽  
Christopher Kwan ◽  
Kristyan Guppy-Coles ◽  
Joanne Sippel ◽  
John Atherton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Troponin I ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Ventricular Diastolic Function ◽  
St Elevation

Introduction: Severe left ventricular diastolic dysfunction is associated with worse prognosis after acute myocardial infarction (MI). Twenty percent of patients have a restrictive filling pattern (RFP) following MI, and this is associated with a fourfold increase in mortality. The determinants of diastolic function in this setting are not well defined. Aim: We sought to determine the correlation between enzymatic infarct size and RFP in patients with a first ever MI. We hypothesized that a larger infarct size would result in greater impairment of left ventricular diastolic function. Methods: Data analysis was performed on consecutive patients admitted with first ever non-ST elevation MI (NSTEMI) or ST-elevation MI (STEMI) to a single large tertiary referral hospital from January 2013 to December 2014. All patients underwent coronary angiography during the index admission. Infarct size was determined by peak troponin I. Doppler transmitral flow pattern was obtained from the initial transthoracic echocardiogram performed within 48 hours of admission. RFP was defined as: E/A ratio >2.0 and/or E-wave deceleration time <160ms (American Society of Echocardiography Guidelines 2009). Results: Data were available on 645 consecutive patients who underwent coronary angiography for MI. We excluded 160 patients with a previous MI. Of the remaining 485 patients (mean age 62±13 years; mean left ventricular ejection fraction (LVEF) 53±12%), there were 338 NSTEMIs (70%) and 147 STEMIs (30%). PCI was performed in 360 (74%) patients (single vessel (82%), ≥2 vessels (18%)); coronary artery bypass surgery in 58 (13%); and medical management in 67 (13%). Sixty-nine patients (14.4%) had RFP; 52% of these had a LVEF ≥45%. Peak troponin I levels were higher in the RFP group (31.8±30.9μg/L vs 16.8±25.2μg/L, p=<0.001). On multivariate analysis, infarct size by peak troponin I (OR 1.02, 95%CI 1.00-1.03, p=0.026) and low LVEF (OR 0.95, 95%CI 0.91-0.99, p=0.015) were the only independent predictors of RFP. Conclusion: Infarct size was a major determinant of diastolic dysfunction following first ever MI. Whilst LV systolic dysfunction was strongly associated with impaired diastolic function, 52% of patients with severe diastolic dysfunction had relatively preserved LVEF.

Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

2020 ◽  
Author(s):  
Mei-Zhen Wu ◽  
Yan Chen ◽  
Yu-Juan Yu ◽  
Zhe Zhen ◽  
Ying-Xian Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Specific Pattern

Abstract Aims  Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodelling, and diastolic dysfunction in patients with type 2 diabetes (T2DM). The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodelling, and diastolic dysfunction in patients with T2DM. Further, the prognostic value of diastolic function in women and men was also evaluated. Methods and results  A total of 350 patients with T2DM (mean age 61 ± 11 years; women, 48.3%) was recruited. Detailed echocardiography was performed at baseline and after 25 months. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization, or myocardial infarction. Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 21 patients developed MACE (5 cardiovascular death, 9 hospitalization for heart failure, and 7 myocardial infarction) during a median follow-up of 56 months. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women [hazard ratio = 6.30; 95% confidence interval (CI) = 1.06–37.54; P &lt; 0.05] but not men (hazard ratio = 2.29, 95% CI = 0.67–7.89; P = 0.19). Conclusion  LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

scholarly journals Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction

2021 ◽  
Author(s):  
Jan Erik Otterstad ◽  
Ingvild Billehaug Norum ◽  
Vidar Ruddox ◽  
An Chau Maria Le ◽  
Bjørn Bendz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction

AbstractGlobal longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice.Trial registration: Current Research information system in Norway (CRISTIN). Id: 506563

P3461Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Z Wu ◽  
Y Chen ◽  
Y J Yu ◽  
H F Tse ◽  
K H Yiu
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Specific Pattern ◽  
Lv Remodeling

Abstract Background Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodeling and diastolic dysfunction in patients with type 2 diabetes (T2DM). Purpose The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodeling and diastolic dysfunction in patients with T2DM. Further the prognostic value of diastolic function in women and men was also evaluated. Methods A total of 386 patients with T2DM (mean age 61±11 years; women, 48.2%) was recruited. Detailed echocardiography was performed and LV geometry, systolic and diastolic function were measured at baseline and follow-up. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization or myocardial infarction. Multivariable cox-regression adjusted for age, hypertension, LVEF and HbA1c was used to assess the association between sex-specific diastolic function and the development of a MACE. Results Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 26 patients developed a MACE (4 cardiovascular death, 14 hospitalization for heart failure, 8 myocardial infarction) during follow-up. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women (hazard ratio 6.35, 95% confidence interval 1.18–34.19, P<0.05) but not men (hazard ratio 1.85, 95% confidence interval 0.58–5.92, P=0.30). Conclusions LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

Left Ventricular Systolic and Diastolic Functions after Cardiac Rehabilitation in Successfully Revascularized Patients with Acute Myocardial Infarction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M I A S Rashed ◽  
I M Bastawy ◽  
H M Khorshid ◽  
A A Sharafeldin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Diastolic Function ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Before And After ◽  
2D Speckle Tracking ◽  
Diastolic Functions

Abstract Background Coronary artery disease (CAD) is a widely prevalent disease with many adverse sequelae. As survival after myocardial infarction or coronary revascularization has improved, cardiac rehabilitation and secondary prevention services have become more important. Advances in ultrasound such as Doppler imaging, strain or strain rate imaging provide comprehensive information on left ventricle (LV) myocardial contractility. Objective to evaluate the possible early effect of intensive supervised Cardiac rehabilitation on the LV systolic and diastolic functions in patients with acute myocardial infarction (AMI) who had been successfully revascularized by primary percutaneous coronary intervention (PCI) using two dimensional (2D) speckle tracking and doppler imaging. Patients and Methods thirty patients with AMI and successfully revascularized by primary PCI were enrolled in the study. LV global longitudinal strain (LVGLS) analysis was performed using 2D speckle tracking echocardiography before and after Cardiac rehabilitation. LV ejection fraction (EF) was measured using the modified Simpson’s method. Pulsed-wave Doppler at the tip of mitral valve leaflets was also done allowing us to measure the early (E) and late (A) diastolic filling velocities, E/A ratio. The LV tissue velocity was measured by TDI of the lateral mitral annulus (e’) and E/e’ was calculated and LV diastolic dysfunction (DD) grade was estimated. Results There was significant improvement in LVEF measurements before and after Cardiac rehabilitation (47.50 ± 6.42 before vs. 52.17 ± 6.64 after; p = 0.000).The improvement in 2D speckle tracking LVGLS after Cardiac rehabilitation was statistically significant (p = 0.000). the diastolic function as assessed by TDI after a 3-month program of exercise-based cardiac rehabilitation has improved with decrease in the number of patients with DD grade I and increase in the number of normal diastolic function with p-value P &lt; 0.01(highly significant). Conclusion cardiac rehabilitation has beneficial effects on LVGLS, LVEF as well as diastolic function after AMI and successful revascularization.

scholarly journals P654 Prognostic evaluation of simplified echocardiographic parameters in acute myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Fonseca Goncalves ◽  
J P Guimaraes ◽  
S C Borges ◽  
J J Monteiro ◽  
P S Mateus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
The Body ◽  
Prognostic Impact ◽  
Prognostic Evaluation ◽  
Percutaneous Coronary ◽  
Echocardiographic Parameters

Abstract Introduction In an era where prognostic evaluation is increasingly being improved by echocardiography in acute myocardial infarction (MI), there are also classic 2D echocardiographic parameters that may have potential and practical utility in this area. The aim of this study was to evaluate the prognostic impact of left ventricular end-diastolic diameter (LVEDD), indexed left atrium volume (VOL) and indexed left ventricular mass (LVM) in ST-segment elevation myocardial infarction (STEMI) patients. Methods Retrospective study of consecutive patients with nonfatal STEMI who underwent percutaneous coronary intervention between January/2015 and December/2017. VOL was calculated by the "Area-Length" and LVM by "Cube formula", both indexed to the body surface area. High parameters were considered when: LVEDD &gt;58mm in man or &gt;52mm in woman; VOL &gt;34mL/m2; LVM &gt;115g/m2 in man or &gt;95g/m2 in woman. At a median follow-up of 46 months (IQR 38-58), the endpoints evaluated were acute myocardial infarction (AMI), decompensated heart failure (DHF), and overall mortality. The analysis of events was adjusted for possible confounding factors. Results A total of 200 patients were identified, 72% of whom were men and the mean age was 63.7 ± 13.0 years. There was an increase of the LVEDD in 17.5%, VOL in 42% and LVM in 16.5%. In the multivariate analysis, LVEDD was able to predict significant DHF (HR 2.4, 95% CI 1.2-4.9) and AMI (HR 6.4, CI 95% 1.6-26.0) and VOL only AMI (HR 6.1, 95% CI 1.2-30.1), but not DHF (HR 1.3, 95% CI 0.7-2.6). The presence of increased LVM was not associated with more events of DHF (HR 1.4, IC95% 0.7-3.0) or AMI (HR 3.7, 95% CI 0.9-14.5). None of these parameters reached statistical significance for mortality (LVEDD: HR 1.0, 95% CI 0.3-3.0, VOL: HR 1.9, 95% CI 0.8-4.4, LVM: HR 1.3, 95% CI 0.5-3.5). In the ROC curve analysis, LVEDD showed an area under the curve (AUC) of 0.7 (95% CI 0.6-0.8) for DHF and 0.6 (95% CI 0.5-0.8) for AMI, whereas VOL demonstrated an AUC of 0.7 (95% CI 0.5-0.9) for AMI. CONCLUSION In patients with nonfatal STEMI who underwent percutaneous coronary intervention, LVEDD and VOL are echocardiographic parameters that may still play some role in prognostic evaluation. The presence of elevated LVM was not associated with a significant increase in cardiovascular events.

scholarly journals The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction

2020 ◽  
Author(s):  
Daniel A Jones ◽  
Paul Wright ◽  
Momin A Alizadeh ◽  
Sadeer Fhadil ◽  
Krishnaraj S Rathod ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Novel Oral Anticoagulants ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Aim Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3–6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI. Methods and results This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2–2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388). Conclusion These data suggest improved thrombus resolution in post-acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.

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