Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction
Patients with acute myocardial infarction are at increased risk of developing atrial fibrillation. We aimed to evaluate whether speckle tracking echocardiography improves risk stratification for atrial fibrillation in these patients. The study comprised of 373 patients with ST-segment elevation myoc...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591166/ https://www.ncbi.nlm.nih.gov/pubmed/27858918 http://dx.doi.org/10.1097/MD.0000000000005338 |
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author | Olsen, Flemming Javier Pedersen, Sune Jensen, Jan Skov Biering-Sørensen, Tor |
author_facet | Olsen, Flemming Javier Pedersen, Sune Jensen, Jan Skov Biering-Sørensen, Tor |
author_sort | Olsen, Flemming Javier |
collection | PubMed |
description | Patients with acute myocardial infarction are at increased risk of developing atrial fibrillation. We aimed to evaluate whether speckle tracking echocardiography improves risk stratification for atrial fibrillation in these patients. The study comprised of 373 patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. Patients had an echocardiogram performed at a median of 2 days after their STEMI. The echocardiograms consisted of conventional measurements and myocardial strain analysis by speckle tracking from 3 apical projections. The endpoint was a composite of new-onset atrial fibrillation and ischemic stroke. At a median follow-up time of 5.5 years (interquartile range 4.9, 6.1 years), 44 patients developed the endpoint (atrial fibrillation: n = 24, ischemic stroke: n = 24, both: n = 4). Patients who reached the endpoint had significantly reduced systolic function by the left ventricular ejection fraction (LVEF) (43% vs 46%; P = 0.042) and global longitudinal strain (10.9% vs 12.6%; P = 0.004), both being univariable predictors. However, only global longitudinal strain remained a significantly independent predictor (hazard ratio 1.12, 95% confidence interval 1.00; 1.25, P = 0.042, per 1% decrease) after multivariable adjustment for baseline predictors (age, sex, diabetes, hypertension, diastolic dysfunction, and LVEF) using Cox regression. Furthermore, global longitudinal strain resulted in significantly higher c-statistics for prediction of outcome compared with LVEF <45% (0.63 vs 0.52; P = 0.026). When stratified into tertiles of global longitudinal strain, it became evident that patients in the lowest tertile mediated this signal with a 2-fold increased risk compared with the highest tertile (hazard ratio 2.10, 95% confidence interval 1.04; 4.25). Global longitudinal strain predicts atrial fibrillation after STEMI and may add valuable information which can help facilitate arrhythmia detection in these patients. |
format | Online Article Text |
id | pubmed-5591166 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-55911662017-09-15 Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction Olsen, Flemming Javier Pedersen, Sune Jensen, Jan Skov Biering-Sørensen, Tor Medicine (Baltimore) 3400 Patients with acute myocardial infarction are at increased risk of developing atrial fibrillation. We aimed to evaluate whether speckle tracking echocardiography improves risk stratification for atrial fibrillation in these patients. The study comprised of 373 patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. Patients had an echocardiogram performed at a median of 2 days after their STEMI. The echocardiograms consisted of conventional measurements and myocardial strain analysis by speckle tracking from 3 apical projections. The endpoint was a composite of new-onset atrial fibrillation and ischemic stroke. At a median follow-up time of 5.5 years (interquartile range 4.9, 6.1 years), 44 patients developed the endpoint (atrial fibrillation: n = 24, ischemic stroke: n = 24, both: n = 4). Patients who reached the endpoint had significantly reduced systolic function by the left ventricular ejection fraction (LVEF) (43% vs 46%; P = 0.042) and global longitudinal strain (10.9% vs 12.6%; P = 0.004), both being univariable predictors. However, only global longitudinal strain remained a significantly independent predictor (hazard ratio 1.12, 95% confidence interval 1.00; 1.25, P = 0.042, per 1% decrease) after multivariable adjustment for baseline predictors (age, sex, diabetes, hypertension, diastolic dysfunction, and LVEF) using Cox regression. Furthermore, global longitudinal strain resulted in significantly higher c-statistics for prediction of outcome compared with LVEF <45% (0.63 vs 0.52; P = 0.026). When stratified into tertiles of global longitudinal strain, it became evident that patients in the lowest tertile mediated this signal with a 2-fold increased risk compared with the highest tertile (hazard ratio 2.10, 95% confidence interval 1.04; 4.25). Global longitudinal strain predicts atrial fibrillation after STEMI and may add valuable information which can help facilitate arrhythmia detection in these patients. Wolters Kluwer Health 2016-11-04 /pmc/articles/PMC5591166/ /pubmed/27858918 http://dx.doi.org/10.1097/MD.0000000000005338 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0 |
spellingShingle | 3400 Olsen, Flemming Javier Pedersen, Sune Jensen, Jan Skov Biering-Sørensen, Tor Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title | Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title_full | Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title_fullStr | Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title_full_unstemmed | Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title_short | Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
title_sort | global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction |
topic | 3400 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591166/ https://www.ncbi.nlm.nih.gov/pubmed/27858918 http://dx.doi.org/10.1097/MD.0000000000005338 |
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