Prognostic Significance of Echocardiographic Characteristics in Patients with Type 2 Myocardial Infarction: comparison with Type 1 Myocardial Infarction

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Rational Pharmacotherapy in Cardiology Pub Date : 2023-11-07 DOI:10.20996/1819-6446-2023-2940

T. H. Hoang, V. Maiskov, I. Merai, A. F. Safarova, Z. Kobalava

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Abstract

Aim. To outline echocardiographic features and assess their prognostic significance for major cardiovascular adverse events (MACEs) within 12 months in patients with type 2 myocardial infarction (MI), compared to type 1 MI (T1MI).Material and methods. The prospective observational study included 161 MI patients who underwent coronary angiography within 24 hours of admission. Type 2 MI (T2MI) diagnosis aligned with the Fourth Universal Definition. Echocardiography and speckle-tracking echocardiography were performed within 72 hours of hospitalization. MACEs encompassed cardiovascular death, non-fatal MI, non-fatal stroke, and HF-related readmissions. Logistic regression analysis was conducted to evaluate their associations with the outcomes.Results. T2MI were diagnosed in 74 patients (median age, 65 years; males, 55,4%). During follow up, 18 patients for each MI type experienced at least one MACE event. Left ventricular (LV) systolic dysfunction (LV ejection fraction [LVEF] <50%) was observed in 41 (55.4%) T2MI patients, compared with 66 (75.9%) T1MI patients (p=0.014). Median LVEF and global longitudinal strain [GLS] were 47.5% and 13.4%, respectively, for T2MI, compared to 45% and 13.9%, respectively, for T1MI (p=0.032 and p=0.332, respectively). LV diastolic dysfunction [DD] was observed in 56 (75.7%) T2MI and 77 (88.5%) T1MI patients. Grade III was more frequent in T2MI in comparison with T1MI (14.9% vs 1.1%, p=0.001, respectively), whereas grade I was more common in T1MI patients (75.9% vs 43.2%, p=0.004, respectively). Right ventricular (RV) dysfunction was observed more frequent in T2MI patients, compared to those with T2MI (52.7% vs. 35.6%, p=0.025, respectively). In univariate analysis, grade III DD was significantly associated with MACEs in T2MI (odds ratio [OR] 5.1, 95% confidence interval [CI], 1.3–18.5, p=0.017). In multivariate analysis, GLS ≤ 9.6% (OR = 17.3, 95% CI 3.0-99.5, p=0.001), and prior MI (OR = 16.6, 95% CI 1.7–157.6, p=0.015) were significantly associated with a heightened risk of MACEs in T2MI patients.Conclusion. Patients with T2MI had high prevalence of LV and RV dysfunction. Echocardiographic assessments, particularly speckle-tracking echocardiography, hold promise in predicting adverse outcomes for these individuals.

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2 型心肌梗死患者超声心动图特征的预后意义：与 1 型心肌梗死的比较

目的与1型心肌梗死（T1MI）相比，概述2型心肌梗死（MI）患者的超声心动图特征，并评估其在12个月内发生主要心血管不良事件（MACEs）的预后意义。这项前瞻性观察研究纳入了 161 名在入院 24 小时内接受冠状动脉造影术的心肌梗死患者。2型心肌梗死（T2MI）的诊断符合第四通用定义。住院 72 小时内进行了超声心动图和斑点追踪超声心动图检查。MACE包括心血管死亡、非致命性心肌梗死、非致命性中风和心房颤动相关再入院。我们进行了逻辑回归分析，以评估它们与结果之间的关联。74名患者被诊断为T2MI（中位年龄为65岁，男性占55.4%）。在随访期间，每种类型的心肌梗死中有18名患者至少发生过一次MACE事件。在41名（55.4%）T2MI患者中观察到左心室收缩功能障碍（左心室射血分数[LVEF]<50%），而在66名（75.9%）T1MI患者中观察到左心室收缩功能障碍（P=0.014）。T2MI 患者的 LVEF 中位数和整体纵向应变[GLS]分别为 47.5% 和 13.4%，而 T1MI 患者的 LVEF 中位数和整体纵向应变[GLS]分别为 45% 和 13.9%（P=0.032 和 P=0.332）。在 56 例（75.7%）T2MI 和 77 例（88.5%）T1MI 患者中观察到左心室舒张功能障碍 [DD]。与 T1MI 相比，T2MI 患者中 III 级更为常见（分别为 14.9% vs 1.1%，P=0.001），而 T1MI 患者中 I 级更为常见（分别为 75.9% vs 43.2%，P=0.004）。与T2MI患者相比，T2MI患者更常见右心室（RV）功能障碍（分别为52.7% vs. 35.6%，P=0.025）。在单变量分析中，III 级 DD 与 T2MI 的 MACEs 显著相关（几率比 [OR] 5.1，95% 置信区间 [CI]，1.3-18.5，P=0.017）。在多变量分析中，GLS ≤ 9.6% （OR = 17.3，95% CI 3.0-99.5，p=0.001）和既往心肌梗死（OR = 16.6，95% CI 1.7-157.6，p=0.015）与 T2MI 患者 MACE 风险增加显著相关。T2MI患者左心室和左心室功能障碍的发生率很高。超声心动图评估，尤其是斑点追踪超声心动图，有望预测这些患者的不良预后。

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来源期刊

Rational Pharmacotherapy in Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

1.00

自引率

50.00%

发文量

审稿时长

6 weeks

期刊介绍： The primary goals of the Journal are consolidation of information on scientific and practical achievements in pharmacotherapy and prevention of cardiovascular diseases and continuing education of cardiologists and internists. The scientific concept of the edition suggests the publication of information on current achievements in cardiology, the results of national and international clinical trials. The Journal publishes original articles on the results of clinical trials designed to study the effectiveness and safety of drugs, analysis of clinical practice and its compliance with national and international recommendations, expert s’ opinions on a wide range of cardiology issues, associated conditions and clinical pharmacology. There is a heading “Preventive cardiology and public health” in the Journal to stimulate research interest in this highly demanded area. Memories of the outstanding people in medicine including cardiology, which are of great interest to historians of medicine, are published in "Our Mentors” heading.