TY - JOUR
T1 - A Validated Echocardiographic Risk Model for Predicting Outcome Following ST-segment Elevation Myocardial Infarction
AU - Olsen, Flemming Javier
AU - Pedersen, Sune
AU - Skaarup, Kristoffer Grundtvig
AU - Iversen, Allan Zeeberg
AU - Modin, Daniel
AU - Nochioka, Kotaro
AU - Biering-Sørensen, Tor
N1 - Funding Information:
Funding: FJO was funded by grants from the Herlev and Gentofte Hospital's Research Council , the Danish Heart Foundation during preparation of this manuscript, and was also recipient of the OSVAL award from the Medical Society of Copenhagen for this study. TBS was supported by the Fondsbørsvekselerer Henry Hansen og Hustrus Hovedlegat. The sponsors had no role in study design, data collection, data analysis, interpretation of data or writing of the manuscript.
Funding Information:
Funding: FJO was funded by grants from the Herlev and Gentofte Hospital's Research Council, the Danish Heart Foundation during preparation of this manuscript, and was also recipient of the OSVAL award from the Medical Society of Copenhagen for this study. TBS was supported by the Fondsb?rsvekselerer Henry Hansen og Hustrus Hovedlegat. The sponsors had no role in study design, data collection, data analysis, interpretation of data or writing of the manuscript.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/5/15
Y1 - 2020/5/15
N2 - Many echocardiographic measures have been proposed as potential predictors of outcome following ST-elevation myocardial infarction (STEMI). We hypothesized that combining multiple echocardiographic measures in a risk model provides more prognostic information than individual echocardiographic measures. We prospectively included 373 STEMI patients which constituted our derivation cohort. We also identified 298 STEMI patients from a clinical registry that constituted our validation cohort. Echocardiogram was performed at a median of 2 days after infarction. The echocardiogram consisted of conventional and advanced measures. The end point was a composite of heart failure and/or cardiovascular death. During a median follow-up of 5.4 years, we observed 80 events in our derivation cohort. A stepwise backward Cox regression including all echocardiographic parameters identified global longitudinal strain, wall motion score index (WMSI), E/e’, and E/global strain rate e (E/GLSRe) as significant predictors of outcome. A Classification and Regression Tree analysis outlined a risk model with WMSI, GLSRe, and E/e’ as key echocardiographic parameters. Patients with WMSI ≥ 2.22 were at high risk, patients with WMSI < 2.22, GLSRe < 0.82s−1 and E/e’≥7.6 at intermediate risk, and patients with WMSI < 2.22 and GLSRe ≥ 0.82s−1 or GLSRe < 0.82s−1 and E/e’ < 7.6 at low risk of heart failure and/or cardiovascular death. When compared with the low-risk group, an incremental risk was observed (intermediate group: HR = 2.52 [1.24;5.11], p = 0.011; high-risk group: HR = 4.37 [1.40;13.66], p = 0.011). The risk model was validated in the validation cohort (C-statistic: 0.71). In conclusion, we devised an echocardiographic risk model for STEMI patients suggesting advanced and conventional measures of systolic function and filling pressures to be important for the prognosis.
AB - Many echocardiographic measures have been proposed as potential predictors of outcome following ST-elevation myocardial infarction (STEMI). We hypothesized that combining multiple echocardiographic measures in a risk model provides more prognostic information than individual echocardiographic measures. We prospectively included 373 STEMI patients which constituted our derivation cohort. We also identified 298 STEMI patients from a clinical registry that constituted our validation cohort. Echocardiogram was performed at a median of 2 days after infarction. The echocardiogram consisted of conventional and advanced measures. The end point was a composite of heart failure and/or cardiovascular death. During a median follow-up of 5.4 years, we observed 80 events in our derivation cohort. A stepwise backward Cox regression including all echocardiographic parameters identified global longitudinal strain, wall motion score index (WMSI), E/e’, and E/global strain rate e (E/GLSRe) as significant predictors of outcome. A Classification and Regression Tree analysis outlined a risk model with WMSI, GLSRe, and E/e’ as key echocardiographic parameters. Patients with WMSI ≥ 2.22 were at high risk, patients with WMSI < 2.22, GLSRe < 0.82s−1 and E/e’≥7.6 at intermediate risk, and patients with WMSI < 2.22 and GLSRe ≥ 0.82s−1 or GLSRe < 0.82s−1 and E/e’ < 7.6 at low risk of heart failure and/or cardiovascular death. When compared with the low-risk group, an incremental risk was observed (intermediate group: HR = 2.52 [1.24;5.11], p = 0.011; high-risk group: HR = 4.37 [1.40;13.66], p = 0.011). The risk model was validated in the validation cohort (C-statistic: 0.71). In conclusion, we devised an echocardiographic risk model for STEMI patients suggesting advanced and conventional measures of systolic function and filling pressures to be important for the prognosis.
UR - http://www.scopus.com/inward/record.url?scp=85082715740&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85082715740&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2020.02.024
DO - 10.1016/j.amjcard.2020.02.024
M3 - Article
C2 - 32241549
AN - SCOPUS:85082715740
VL - 125
SP - 1461
EP - 1470
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 10
ER -