| Mechanical dispersion assessed by myocardial strain in patients after myocardial infarction for risk prediction of ventricular arrhythmia. | |
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MedLine Citation:
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PMID: 20223421 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The aim of this study was to investigate whether myocardial strain echocardiography can predict ventricular arrhythmias in patients after myocardial infarction (MI). BACKGROUND: Left ventricular (LV) ejection fraction (EF) is insufficient for selecting patients for implantable cardioverter-defibrillator (ICD) therapy after MI. Electrical dispersion in infarcted myocardium facilitates malignant arrhythmia. Myocardial strain by echocardiography can quantify detailed regional and global myocardial function and timing. We hypothesized that electrical abnormalities in patients after MI will lead to LV mechanical dispersion, which can be measured as regional heterogeneity of contraction by myocardial strain. METHODS: We prospectively included 85 post-MI patients, 44 meeting primary and 41 meeting secondary ICD prevention criteria. After 2.3 years (range 0.6 to 5.5 years) of follow-up, 47 patients had no and 38 patients had 1 or more recorded arrhythmias requiring appropriate ICD therapy. Longitudinal strain was measured by speckle tracking echocardiography. The SD of time to maximum myocardial shortening in a 16-segment LV model was calculated as a parameter of mechanical dispersion. Global strain was calculated as average strain in a 16-segment LV model. RESULTS: The EF did not differ between ICD patients with and without arrhythmias occurring during follow-up (34 +/- 11% vs. 35 +/- 9%, p = 0.70). Mechanical dispersion was greater in ICD patients with recorded ventricular arrhythmias compared with those without (85 +/- 29 ms vs. 56 +/- 13 ms, p < 0.001). By Cox regression, mechanical dispersion was a strong and independent predictor of arrhythmias requiring ICD therapy (hazard ratio: 1.25 per 10-ms increase, 95% confidence interval: 1.1 to 1.4, p < 0.001). In patients with an EF >35%, global strain showed better LV function in those without recorded arrhythmias (-14.0% +/- 4.0% vs. -12.0 +/- 3.0%, p = 0.05), whereas the EF did not differ (44 +/- 8% vs. 41 +/- 5%, p = 0.23). CONCLUSIONS: Mechanical dispersion was more pronounced in post-MI patients with recurrent arrhythmias. Global strain was a marker of arrhythmias in post-MI patients with relatively preserved ventricular function. These novel parameters assessed by myocardial strain may add important information about susceptibility for ventricular arrhythmias after MI. |
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Authors:
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Kristina H Haugaa; Marit Kristine Smedsrud; Torkel Steen; Erik Kongsgaard; Jan P?l Loennechen; Terje Skjaerpe; Jens-Uwe Voigt; Rik Willems; Gunnar Smith; Otto A Smiseth; Jan P Amlie; Thor Edvardsen |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JACC. Cardiovascular imaging Volume: 3 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-12 Completed Date: 2010-06-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
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Languages: eng Pagination: 247-56 Citation Subset: IM |
Copyright Information:
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Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, Rikshospitalet University Hospital and University of Oslo, Oslo, Norway. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Arrhythmias, Cardiac / etiology, physiopathology, prevention & control, ultrasonography* Belgium Case-Control Studies Defibrillators, Implantable Echocardiography* Electric Countershock / instrumentation Electrocardiography Female Humans Kaplan-Meiers Estimate Male Middle Aged Myocardial Contraction* Myocardial Infarction / complications, physiopathology, ultrasonography* Norway Predictive Value of Tests Primary Prevention Proportional Hazards Models Prospective Studies Recurrence Risk Assessment Risk Factors Secondary Prevention Ventricular Function, Left* |
| Comments/Corrections | |
Comment In:
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JACC Cardiovasc Imaging. 2010 Mar;3(3):330-1
[PMID:
20223434
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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