Novel combined echocardiographic score comprising prognostically validated measures of left ventricular size and function to predict long-term survival following myocardial infarction: A proposal to improve risk stratification

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2024-09-06 DOI:10.1111/echo.15922

Sandhir B. Prasad MBBS, PhD, FRACP, Nicole Ivy Chan MD, Anish Krishnan MBBS, MClinEpi, Paul Martin MBBS, PhD, FRACP, Peter Stewart MBBS, FRACP, Michael Mallouhi BSc, William Vollbon BSc, John J. Atherton MBBS, PhD, FRACP

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引用次数: 0

Abstract

Background

While left ventricular ejection fraction (LVEF) is the primary variable utilized for prognosis following myocardial infarction (MI), it is relatively indiscriminate for survival in patients with mildly reduced (> 40%) or preserved LVEF (> 50%). Improving risk stratification in patients with mildly reduced or preserved LVEF remains an unmet need, and could be achieved by using a combination approach using prognostically validated measures of left-ventricular (LV) size, geometry, and function.

Aims

The aim of this study was to compare the prognostic utility of a Combined Echo-Score for predicting all-cause (ACM) and cardiac mortality (CM) following MI to LVEF alone, including the sub-groups with LVEF > 40% and LVEF > 50%.

Methods

Retrospective data on 3094 consecutive patients with MI from 2013 to 2021 who had inpatient echocardiography were included, including both patients with ST-elevation MI (n = 869 [28.1%]) and non-ST-elevation MI (n = 2225 [71.9%]). Echo-Score consisted of LVEF < 40% (2 points) or LVEF < 50% (1 point), and 1 point each for left atrial volume index > 34 mL/m², septal E/eʹ > 15, abnormal LV mass-index, tricuspid regurgitation velocity > 2.8 m/s, and abnormal LV end-systolic volume-index. Simple addition was used to derive a score out of 7.

Results

At a median follow-up of 4.5 years there were 445 deaths (130 cardiac deaths). On Cox proportional-hazards multivariable analysis incorporating significant clinical and echocardiographic predictors, Echo-Score was an independent predictor of both ACM (HR 1.34, p < .001) and CM (HR 1.59, p < .001). Inter-model comparisons of model 𝛘², Harrel's C and Somer's D, and Receiver operating curves confirmed the superior prognostic value of Echo-Score for both endpoints compared to LVEF. In the subgroups with LVEF > 40% and LVEF > 50%, Echo-Score was similarly superior to LVEF for predicting ACM and CM.

Conclusions

An Echo-Score composed of prognostically validated LV parameters is superior to LVEF alone for predicting survival in patients with MI, including the subgroups with mildly reduced and preserved LVEF. This could lead to improved patient risk stratification, better-targeted therapies, and potentially more efficient use of device therapies. Further studies should be considered to define the benefit of further investigation and treatment in high-risk subgroups.

Abstract Image

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由经预后验证的左心室大小和功能测量指标组成的新型超声心动图综合评分，用于预测心肌梗死后的长期存活率：改善风险分层的建议。

背景：虽然左心室射血分数（LVEF）是心肌梗死（MI）后预后判断的主要变量，但它对左心室射血分数轻度降低（> 40%）或保留（> 50%）患者的存活率影响相对较小。目的：本研究的目的是比较联合回声评分与单纯 LVEF（包括 LVEF > 40% 和 LVEF > 50% 的亚组）在预测心肌梗死后全因（ACM）和心脏死亡率（CM）方面的预后效用：研究纳入了2013年至2021年期间连续3094例接受住院超声心动图检查的心肌梗死患者的回顾性数据，包括ST段抬高型心肌梗死患者（n = 869 [28.1%]）和非ST段抬高型心肌梗死患者（n = 2225 [71.9%]）。Echo-Score 包括 LVEF 34 mL/m2、室间隔 E/e' > 15、左心室质量指数异常、三尖瓣反流速度 > 2.8 m/s、左心室收缩末期容积指数异常。结果：中位随访 4.5 年，共有 445 人死亡（130 人死于心脏病）。在包含重要临床和超声心动图预测因素的 Cox 比例危险度多变量分析中，Echo-Score 是 ACM 的独立预测因素（HR 1.34，p 2，Harrel's C 和 Somer's D，Receiver Operation Curves）。在 LVEF > 40% 和 LVEF > 50% 的亚组中，Echo-Score 在预测 ACM 和 CM 方面同样优于 LVEF：结论：由经过预后验证的左心室参数组成的 Echo-Score 在预测心肌梗死患者（包括 LVEF 轻度减低和 LVEF 保留的亚组）的生存率方面优于单纯的 LVEF。这将有助于改善患者的风险分层，提供更有针对性的疗法，并有可能提高设备疗法的使用效率。应考虑开展进一步的研究，以确定对高风险亚组进行进一步检查和治疗的益处。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.