Elevated end‐diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay
Background Acute myocardial infarction (MI) leads to ventricular remodeling in response to oxygen demand. Such changes include left ventricular (LV) dilatation and increased myocardial wall stress. Prior studies showed that wall stress is a vital parameter of cardiac remodeling. However, outcome dat...
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| Veröffentlicht in: | Echocardiography (Mount Kisco, N.Y.) N.Y.), 2018-11, Vol.35 (11), p.1721-1728 |
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| creator | Mosleh, Wassim Elango, Kalaimani Shah, Tanvi Chaudhari, Milind Gandhi, Sumeet Kattel, Sharma Karki, Roshan Khalil, Charl Frodey, Kevin Dahal, Suraj Okeeffe, Cale Aljebaje, Zaid Nagahama, Makoto Punnanithinont, Natdanai Sharma, Umesh C. |
| description | Background
Acute myocardial infarction (MI) leads to ventricular remodeling in response to oxygen demand. Such changes include left ventricular (LV) dilatation and increased myocardial wall stress. Prior studies showed that wall stress is a vital parameter of cardiac remodeling. However, outcome data are lacking. We aim to investigate wall stress post‐MI in relation to biomarkers of cardiac remodeling and cardiovascular outcomes.
Methods
Patients presenting with ST‐elevation MI (STEMI) requiring primary percutaneous intervention (PCI) were enrolled prospectively. LVEF and volume‐based end‐diastolic (EDWS) and end‐systolic (ESWS) wall stress were measured from predischarge echocardiograms. Serum samples were collected for measurement of serum biomarkers. We identified 81 patients meeting inclusion criteria (64% men, 36% women) with a mean age of 61. The primary outcome was major adverse cardiovascular events (MACE) defined as 1‐year composite endpoint of cardiac mortality, recurrent MI, revascularization, or stroke. Length of hospitalization (LOH) was recorded.
Results
Major adverse cardiovascular events‐positive patients (n = 12) had significantly higher EDWS levels (15.87 vs 12.33, P = 0.045), and galectin‐3 levels (19.07 vs 11.75, P = 0.015), and lower LVEF (40.0% vs 48.4%, P = 0.023) compared to MACE‐negative patients. Patients with LOH > 72 hours (n = 33) had significantly higher EDWS, galectin‐3, and peak troponin, and lower LVEF compared to patients with LOH |
| doi_str_mv | 10.1111/echo.14136 |
| format | Article |
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Acute myocardial infarction (MI) leads to ventricular remodeling in response to oxygen demand. Such changes include left ventricular (LV) dilatation and increased myocardial wall stress. Prior studies showed that wall stress is a vital parameter of cardiac remodeling. However, outcome data are lacking. We aim to investigate wall stress post‐MI in relation to biomarkers of cardiac remodeling and cardiovascular outcomes.
Methods
Patients presenting with ST‐elevation MI (STEMI) requiring primary percutaneous intervention (PCI) were enrolled prospectively. LVEF and volume‐based end‐diastolic (EDWS) and end‐systolic (ESWS) wall stress were measured from predischarge echocardiograms. Serum samples were collected for measurement of serum biomarkers. We identified 81 patients meeting inclusion criteria (64% men, 36% women) with a mean age of 61. The primary outcome was major adverse cardiovascular events (MACE) defined as 1‐year composite endpoint of cardiac mortality, recurrent MI, revascularization, or stroke. Length of hospitalization (LOH) was recorded.
Results
Major adverse cardiovascular events‐positive patients (n = 12) had significantly higher EDWS levels (15.87 vs 12.33, P = 0.045), and galectin‐3 levels (19.07 vs 11.75, P = 0.015), and lower LVEF (40.0% vs 48.4%, P = 0.023) compared to MACE‐negative patients. Patients with LOH > 72 hours (n = 33) had significantly higher EDWS, galectin‐3, and peak troponin, and lower LVEF compared to patients with LOH < 72 hours. EDWS positively correlated with LOH and galectin‐3. EDWS was an independent predictor of MACE by binomial regression analysis.
Conclusion
End‐diastolic walls tress is a potential prognostic tool for risk stratifying STEMI patients, providing an assessment of the functional consequences of myocardial remodeling. It is predictive of MACE independent of LVEF, associated with longer hospitalizations, and correlates with galectin‐3, a biomarker of cardiac remodeling.</description><identifier>ISSN: 0742-2822</identifier><identifier>EISSN: 1540-8175</identifier><identifier>DOI: 10.1111/echo.14136</identifier><identifier>PMID: 30220086</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Disease ; acute myocardial infarction ; Aged ; Diastole ; echocardiography ; Echocardiography - methods ; Female ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; myocardial wall ; Patient Outcome Assessment ; Percutaneous Coronary Intervention ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; ST Elevation Myocardial Infarction - diagnostic imaging ; ST Elevation Myocardial Infarction - physiopathology ; ST Elevation Myocardial Infarction - therapy ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Pressure - physiology</subject><ispartof>Echocardiography (Mount Kisco, N.Y.), 2018-11, Vol.35 (11), p.1721-1728</ispartof><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3296-673c108d593fe18ea69ffd6497b61e20eaf6bc8614555c93688af452ad16e0b63</citedby><cites>FETCH-LOGICAL-c3296-673c108d593fe18ea69ffd6497b61e20eaf6bc8614555c93688af452ad16e0b63</cites><orcidid>0000-0003-3597-0106 ; 0000-0001-5944-6603</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fecho.14136$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fecho.14136$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30220086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mosleh, Wassim</creatorcontrib><creatorcontrib>Elango, Kalaimani</creatorcontrib><creatorcontrib>Shah, Tanvi</creatorcontrib><creatorcontrib>Chaudhari, Milind</creatorcontrib><creatorcontrib>Gandhi, Sumeet</creatorcontrib><creatorcontrib>Kattel, Sharma</creatorcontrib><creatorcontrib>Karki, Roshan</creatorcontrib><creatorcontrib>Khalil, Charl</creatorcontrib><creatorcontrib>Frodey, Kevin</creatorcontrib><creatorcontrib>Dahal, Suraj</creatorcontrib><creatorcontrib>Okeeffe, Cale</creatorcontrib><creatorcontrib>Aljebaje, Zaid</creatorcontrib><creatorcontrib>Nagahama, Makoto</creatorcontrib><creatorcontrib>Punnanithinont, Natdanai</creatorcontrib><creatorcontrib>Sharma, Umesh C.</creatorcontrib><title>Elevated end‐diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay</title><title>Echocardiography (Mount Kisco, N.Y.)</title><addtitle>Echocardiography</addtitle><description>Background
Acute myocardial infarction (MI) leads to ventricular remodeling in response to oxygen demand. Such changes include left ventricular (LV) dilatation and increased myocardial wall stress. Prior studies showed that wall stress is a vital parameter of cardiac remodeling. However, outcome data are lacking. We aim to investigate wall stress post‐MI in relation to biomarkers of cardiac remodeling and cardiovascular outcomes.
Methods
Patients presenting with ST‐elevation MI (STEMI) requiring primary percutaneous intervention (PCI) were enrolled prospectively. LVEF and volume‐based end‐diastolic (EDWS) and end‐systolic (ESWS) wall stress were measured from predischarge echocardiograms. Serum samples were collected for measurement of serum biomarkers. We identified 81 patients meeting inclusion criteria (64% men, 36% women) with a mean age of 61. The primary outcome was major adverse cardiovascular events (MACE) defined as 1‐year composite endpoint of cardiac mortality, recurrent MI, revascularization, or stroke. Length of hospitalization (LOH) was recorded.
Results
Major adverse cardiovascular events‐positive patients (n = 12) had significantly higher EDWS levels (15.87 vs 12.33, P = 0.045), and galectin‐3 levels (19.07 vs 11.75, P = 0.015), and lower LVEF (40.0% vs 48.4%, P = 0.023) compared to MACE‐negative patients. Patients with LOH > 72 hours (n = 33) had significantly higher EDWS, galectin‐3, and peak troponin, and lower LVEF compared to patients with LOH < 72 hours. EDWS positively correlated with LOH and galectin‐3. EDWS was an independent predictor of MACE by binomial regression analysis.
Conclusion
End‐diastolic walls tress is a potential prognostic tool for risk stratifying STEMI patients, providing an assessment of the functional consequences of myocardial remodeling. It is predictive of MACE independent of LVEF, associated with longer hospitalizations, and correlates with galectin‐3, a biomarker of cardiac remodeling.</description><subject>Acute Disease</subject><subject>acute myocardial infarction</subject><subject>Aged</subject><subject>Diastole</subject><subject>echocardiography</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>myocardial wall</subject><subject>Patient Outcome Assessment</subject><subject>Percutaneous Coronary Intervention</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>ST Elevation Myocardial Infarction - diagnostic imaging</subject><subject>ST Elevation Myocardial Infarction - physiopathology</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Pressure - physiology</subject><issn>0742-2822</issn><issn>1540-8175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90btu2zAUgGGiaNA4l6UPUHAsCighKYmSxsJwLoCBLMksHJOHNgtKdEnKgbc-QpFH7JOEjtOO5XIGfvgJ8BDymbMrns81qo2_4hUv5Qcy43XFipY39UcyY00lCtEKcUrOYvzBGGs4rz6R05IJwVgrZ-Rl4XAHCTXFUf_59VtbiMk7q-gzOEdjChgjBZMwUFBTQjrsvYKQnaN2NBBUsn6k24DaqpSp3mGISN-M30FUk4NA_ZSUHzDfj5o6P65zb-Pj1qbccTiu04Z6k9-D_QU5MeAiXr7Pc_J0s3ic3xXLh9v7-fdloUrRyUI2peKs1XVXGuQtguyM0bLqmpXkKBiCkSvVSl7Vda26UrYtmKoWoLlEtpLlOfl67G6D_zlhTP1go0LnYEQ_xV7kumgEqw7025Gq4GMMaPptsAOEfc9Zf9hBf9hB_7aDjL-8d6fVgPof_fvpGfAjeLYO9_9J9Yv53cMx-gqf6JXw</recordid><startdate>201811</startdate><enddate>201811</enddate><creator>Mosleh, Wassim</creator><creator>Elango, Kalaimani</creator><creator>Shah, Tanvi</creator><creator>Chaudhari, Milind</creator><creator>Gandhi, Sumeet</creator><creator>Kattel, Sharma</creator><creator>Karki, Roshan</creator><creator>Khalil, Charl</creator><creator>Frodey, Kevin</creator><creator>Dahal, Suraj</creator><creator>Okeeffe, Cale</creator><creator>Aljebaje, Zaid</creator><creator>Nagahama, Makoto</creator><creator>Punnanithinont, Natdanai</creator><creator>Sharma, Umesh C.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3597-0106</orcidid><orcidid>https://orcid.org/0000-0001-5944-6603</orcidid></search><sort><creationdate>201811</creationdate><title>Elevated end‐diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay</title><author>Mosleh, Wassim ; Elango, Kalaimani ; Shah, Tanvi ; Chaudhari, Milind ; Gandhi, Sumeet ; Kattel, Sharma ; Karki, Roshan ; Khalil, Charl ; Frodey, Kevin ; Dahal, Suraj ; Okeeffe, Cale ; Aljebaje, Zaid ; Nagahama, Makoto ; Punnanithinont, Natdanai ; Sharma, Umesh C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3296-673c108d593fe18ea69ffd6497b61e20eaf6bc8614555c93688af452ad16e0b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute Disease</topic><topic>acute myocardial infarction</topic><topic>Aged</topic><topic>Diastole</topic><topic>echocardiography</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>myocardial wall</topic><topic>Patient Outcome Assessment</topic><topic>Percutaneous Coronary Intervention</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ST Elevation Myocardial Infarction - diagnostic imaging</topic><topic>ST Elevation Myocardial Infarction - physiopathology</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Pressure - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mosleh, Wassim</creatorcontrib><creatorcontrib>Elango, Kalaimani</creatorcontrib><creatorcontrib>Shah, Tanvi</creatorcontrib><creatorcontrib>Chaudhari, Milind</creatorcontrib><creatorcontrib>Gandhi, Sumeet</creatorcontrib><creatorcontrib>Kattel, Sharma</creatorcontrib><creatorcontrib>Karki, Roshan</creatorcontrib><creatorcontrib>Khalil, Charl</creatorcontrib><creatorcontrib>Frodey, Kevin</creatorcontrib><creatorcontrib>Dahal, Suraj</creatorcontrib><creatorcontrib>Okeeffe, Cale</creatorcontrib><creatorcontrib>Aljebaje, Zaid</creatorcontrib><creatorcontrib>Nagahama, Makoto</creatorcontrib><creatorcontrib>Punnanithinont, Natdanai</creatorcontrib><creatorcontrib>Sharma, Umesh C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mosleh, Wassim</au><au>Elango, Kalaimani</au><au>Shah, Tanvi</au><au>Chaudhari, Milind</au><au>Gandhi, Sumeet</au><au>Kattel, Sharma</au><au>Karki, Roshan</au><au>Khalil, Charl</au><au>Frodey, Kevin</au><au>Dahal, Suraj</au><au>Okeeffe, Cale</au><au>Aljebaje, Zaid</au><au>Nagahama, Makoto</au><au>Punnanithinont, Natdanai</au><au>Sharma, Umesh C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elevated end‐diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay</atitle><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle><addtitle>Echocardiography</addtitle><date>2018-11</date><risdate>2018</risdate><volume>35</volume><issue>11</issue><spage>1721</spage><epage>1728</epage><pages>1721-1728</pages><issn>0742-2822</issn><eissn>1540-8175</eissn><abstract>Background
Acute myocardial infarction (MI) leads to ventricular remodeling in response to oxygen demand. Such changes include left ventricular (LV) dilatation and increased myocardial wall stress. Prior studies showed that wall stress is a vital parameter of cardiac remodeling. However, outcome data are lacking. We aim to investigate wall stress post‐MI in relation to biomarkers of cardiac remodeling and cardiovascular outcomes.
Methods
Patients presenting with ST‐elevation MI (STEMI) requiring primary percutaneous intervention (PCI) were enrolled prospectively. LVEF and volume‐based end‐diastolic (EDWS) and end‐systolic (ESWS) wall stress were measured from predischarge echocardiograms. Serum samples were collected for measurement of serum biomarkers. We identified 81 patients meeting inclusion criteria (64% men, 36% women) with a mean age of 61. The primary outcome was major adverse cardiovascular events (MACE) defined as 1‐year composite endpoint of cardiac mortality, recurrent MI, revascularization, or stroke. Length of hospitalization (LOH) was recorded.
Results
Major adverse cardiovascular events‐positive patients (n = 12) had significantly higher EDWS levels (15.87 vs 12.33, P = 0.045), and galectin‐3 levels (19.07 vs 11.75, P = 0.015), and lower LVEF (40.0% vs 48.4%, P = 0.023) compared to MACE‐negative patients. Patients with LOH > 72 hours (n = 33) had significantly higher EDWS, galectin‐3, and peak troponin, and lower LVEF compared to patients with LOH < 72 hours. EDWS positively correlated with LOH and galectin‐3. EDWS was an independent predictor of MACE by binomial regression analysis.
Conclusion
End‐diastolic walls tress is a potential prognostic tool for risk stratifying STEMI patients, providing an assessment of the functional consequences of myocardial remodeling. It is predictive of MACE independent of LVEF, associated with longer hospitalizations, and correlates with galectin‐3, a biomarker of cardiac remodeling.</abstract><cop>United States</cop><pmid>30220086</pmid><doi>10.1111/echo.14136</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3597-0106</orcidid><orcidid>https://orcid.org/0000-0001-5944-6603</orcidid></addata></record> |
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| ispartof | Echocardiography (Mount Kisco, N.Y.), 2018-11, Vol.35 (11), p.1721-1728 |
| issn | 0742-2822 1540-8175 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Acute Disease acute myocardial infarction Aged Diastole echocardiography Echocardiography - methods Female Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Length of Stay - statistics & numerical data Male Middle Aged myocardial wall Patient Outcome Assessment Percutaneous Coronary Intervention Predictive Value of Tests Prospective Studies Risk Assessment Risk Factors ST Elevation Myocardial Infarction - diagnostic imaging ST Elevation Myocardial Infarction - physiopathology ST Elevation Myocardial Infarction - therapy Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - physiopathology Ventricular Pressure - physiology |
| title | Elevated end‐diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay |
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