Left ventricular global function index: Relation with infarct characteristics and left ventricular ejection fraction after STEMI
TL;DR: Mikkel Schoos, Roxana Mehran, Usman Baber, Ke Xu, Frederick Feit, Bernard j Gersh,Bernhard Witzenbichler, Gregg W. Stone Mount Sinai Medical Center, New York, NY, USA, Copenhagen, Denmark.
About: This article is published in International Journal of Cardiology.The article was published on 2014-08-20. It has received 12 citations till now. The article focuses on the topics: Electrocardiography in myocardial infarction & Ejection fraction.
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TL;DR: The comprehensive evaluation of STEMI patients by CMR imaging has the potential to provide incremental prognostic information for risk stratification beyond established clinical risk markers.
Abstract: Purpose of reviewThis review summarizes the currently available evidence for the use of cardiac magnetic resonance (CMR) imaging for risk stratifying patients after ST-elevation myocardial infarction (STEMI).Recent findingsGrowing evidence indicates that CMR imaging allows a comprehensive prognosis
41 citations
TL;DR: An overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction is provided.
Abstract: Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.
36 citations
TL;DR: LVGFI assessed by CMR is a strong predictor of MACE within 3 years after first STEMI, and a superior predictive value as compared with LVEF was not found in this study.
Abstract: Aims The left ventricular global function index (LVGFI) is a novel indicator of left ventricular performance. Its prognostic value in patients after ST-segment elevation myocardial infarction (STEMI) is unknown. We sought to evaluate the prognostic significance of LVGFI measured by cardiovascular magnetic resonance (CMR) imaging after STEMI.
Methods and results Two hundred eligible STEMI patients (56 ± 11 years, 16% female) revascularized by primary percutaneous coronary intervention were followed-up for 3.1 [2–4.1] years for major adverse cardiac events (MACE). MACE was defined as a composite of death, non-fatal myocardial re-infarction, and new congestive heart failure. All patients underwent CMR imaging within 2 [2–4] days after STEMI. Late enhancement and cine images were acquired to assess myocardial injury as well as myocardial function, including LVGFI. Patients suffering a MACE event ( n = 20, 10%) had a significantly lower LVGFI ( P = 0.001). In Kaplan–Meier analysis, a decreased LVGFI was associated with a reduced MACE-free survival ( P < 0.001). Multivariate Cox regression analysis revealed a decreased LVGFI as a predictor for MACE [hazard ratio = 4.79, 95% confidence interval (CI) 1.46–15.67, P = 0.010] after adjusting for microvascular obstruction, left ventricular mass, and multivessel disease. In receiver operating characteristic analysis, LVGFI was a strong predictor for MACE (area under the curve = 0.73, CI 0.61–0.85). However, c -statistics revealed that LVGFI does not provide incremental prognostic information over left ventricular ejection fraction (LVEF) ( P = 0.38).
Conclusion LVGFI assessed by CMR is a strong predictor of MACE within 3 years after first STEMI. A superior predictive value as compared with LVEF was not found in this study.
34 citations
Cites background or methods from "Left ventricular global function in..."
...The left ventricular global function index (LVGFI) was recently proposed as such a novel measure of LV performance.(13,14) The formula for the calculation of the LVGFI combines LV stroke-, end-systolic, and enddiastolic volumes, and LV mass....
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...We havepreviously shown the relation of LVGFI with infarct characteristics after acute STEMI.(14)...
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TL;DR: The LVGFI strongly correlates with markers of severe myocardial and microvascular damage in patients with STEMI, offering prognostic information beyond traditional cardiac risk factors including the LVEF.
Abstract: The left ventricular performance index (LVGFI) as a comprehensive marker of cardiac performance integrates LV structure with global function within one index. In a prospective cohort study of healthy individuals the LVGFI demonstrated a superior prognostic value as compared to LV ejection fraction (LVEF). In patients after ST-segment elevation myocardial infarction (STEMI), however, the role of the LVGFI is unknown. Aim of this study was to investigate the relationship between the LVGFI and infarct characteristics as well as prognosis in a large multicenter STEMI population. In total 795 STEMI patients reperfused by primary angioplasty (<12 h after symptom onset) underwent cardiovascular magnetic resonance (CMR) at 8 centers. CMR was completed within one week after infarction using a standardized protocol including LV dimensions, mass and function for calculation of the LVGFI. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE). The median LVGFI was 31.2 % (interquartile range 25.7 to 36.6). Patients with LVGFI < median had significantly larger infarcts, less myocardial salvage, a larger extent of microvascular obstruction, higher incidence of intramyocardial hemorrhage and more pronounced LV dysfunction (p < 0.001 for all). MACE and mortality rates were significantly higher in the LVGFI < median group (p < 0.001 and p = 0.003, respectively). The LVGFI had an incremental prognostic value in addition to LVEF for prediction of all-cause mortality. The LVGFI strongly correlates with markers of severe myocardial and microvascular damage in patients with STEMI, offering prognostic information beyond traditional cardiac risk factors including the LVEF. ClinicalTrials.gov: NCT00712101
33 citations
Cites background or result from "Left ventricular global function in..."
...In patients after acute MI, the LVGFI has only been investigated in one pooled retrospective, single-center, observational study [8]....
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...In patients after acute MI only one small singlecenter study assessed the relation between the LVGFI and infarct characteristics, however, the prognostic role of the LVGFI after reperfused AMI is completely unknown [8]....
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...[8] we found a marked reduction of the mean LVGFI in STEMI patients when compared with a healthy multiethnic population (42 ± 6 % in the Multi-Ethnic Study of Atherosclerosis [MESA], versus 31 ± 8 % in the current study) [7]....
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TL;DR: The present study showed an association of aortic stiffness and hs-TnT concentrations at a chronic stage after acute ST-segment elevation myocardial infarction (STEMI).
Abstract: OBJECTIVES Aortic pulse wave velocity (PWV)--the proposed gold standard for the assessment of aortic stiffness--is a major determinant of left ventricular after-load and coronary perfusion. We aimed to investigate the association between aortic PWV and subclinical elevation of high-sensitivity cardiac troponin T (hs-TnT) concentrations at a chronic stage after acute ST-segment elevation myocardial infarction (STEMI). METHODS Seventy-four patients with acute STEMI were included in this cross-sectional single-centre study at the University Hospital of Innsbruck. All patients underwent cardiac MRI for the assessment of left ventricular function, morphology, infarct size and aortic PWV 12 months after acute STEMI. Blood samples were drawn at 12 months by peripheral venipuncture. Levels of hs-TnT were measured by a commercially available immunoassay (Roche Diagnostics). RESULTS hs-TnT levels (6.4 ng/l, inter-quartile range 5.0-8.6) were significantly associated with age (r = 0.417, P < 0.001), plasma creatinine levels (r = 0.257, P = 0.027), high-sensitivity C-reactive protein levels (r = 0.281, P = 0.015) and aortic PWV (r = 0.435, P < 0.001). Multiple linear regression analysis revealed aortic PWV (s = 0.330, P = 0.025), apart from plasma creatinine concentrations (s = 0.279, P = 0.010), to be independently associated with hs-TnT concentrations (model: R = 0.597, P < 0.001). CONCLUSION The present study showed an association of aortic stiffness and hs-TnT concentrations at a chronic stage after STEMI.
14 citations
References
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TL;DR: LVEF is a powerful predictor of cardiovascular outcome in heart failure patients across a broad spectrum of ventricular function, and once elevated to a range above 45%, ejection fraction does not further contribute to assessment of cardiovascular risk inheart failure patients.
Abstract: Background— Left ventricular function is a principal determinant of cardiovascular risk in patients with heart failure. The growing number of patients with preserved systolic function heart failure underscores the importance of understanding the relationship between ejection fraction and risk. Methods and Results— We studied 7599 patients with a broad spectrum of symptomatic heart failure enrolled in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program. All patients were randomized to candesartan at a target dose of 32 mg once daily or matching placebo and followed up for a median of 38 months. We related left ventricular ejection fraction (LVEF), measured before randomization at the sites, to cardiovascular outcomes and causes of death. Mean LVEF in patients enrolled in CHARM was 38.8±14.9% (median LVEF 36%). Patients with lower LVEF tended to have higher baseline New York Heart Association class. The hazard ratio for all-cause mortality increased by 39% fo...
699 citations
TL;DR: Acute infarct size, EF and ESVI can predict the development of future cardiac events and is a stronger predictor of future events than measures of LV systolic performance.
Abstract: Objectives: Ejection fraction (EF) and end-systolic volume index (ESVI) are established predictors of outcomes following ST-segment elevation myocardial infarction (STEMI). We sought to assess the relative impact of infarct size, EF and ESVI on clinical outcomes and left ventricular (LV) remodelling. Design: Prospective cohort study. Setting: Academic hospital in Chicago, USA. Patients: 122 patients with STEMI following acute percutaneous reperfusion. Main outcome measures: Death, recurrent myocardial infarction (MI) and heart failure. Methods: Cardiac magnetic resonance imaging was obtained within 1 week following STEMI in 122 subjects. ESVI, EF and infarct size were tested for the association with outcomes over 2 years in 113 subjects, and a repeat study was obtained 4 months later to assess LV remodelling in 91 subjects. Results: Acute infarct size correlated linearly with the initial ESVI (r = 0.69, p 2 ; p = 0.005). Conclusions: Infarct size, EF and ESVI can predict the development of future cardiac events. Acute infarct size, which is independent of LV stunning and loading, directly relates to LV remodelling and is a stronger predictor of future events than measures of LV systolic performance.
436 citations
TL;DR: In this article, the authors examined treatment and outcomes in patients admitted to the hospital with acute myocardial infarction (AMI) complicated by congestive heart failure (CHF).
295 citations
TL;DR: Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.
Abstract: Early and late microvascular obstruction (MVO) assessed by cardiovascular magnetic resonance (CMR) are prognostic markers for short-term clinical endpoints after acute ST-elevation myocardial infarction (STEMI). However, there is a lack of studies with long-term follow-up periods (>24 months). STEMI patients reperfused by primary angioplasty (n = 129) underwent MRI at a median of 2 days after the index event. Early MVO was determined on dynamic Gd first-pass images directly after the administration of 0.1 mmol/kg bodyweight Gd-based contrast agent. Furthermore, ejection fraction (EF, %), left ventricular myocardial mass (LVMM) and total infarct size (% of LVMM) were determined with CMR. Clinical follow-up was conducted after a median of 52 months. The primary endpoint was defined as a composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization. Follow-up was completed by 107 patients. 63 pre-defined events occurred during follow-up. Initially, 74 patients showed early MVO. Patients with early MVO had larger infarcts (mean: 24.9 g vs. 15.5 g, p = 0.002) and a lower EF (mean: 39% vs. 46%, p = 0.006). The primary endpoint occurred in 66.2% of patients with MVO and in 42.4% of patients without MVO (p < 0.05). The presence of early MVO was associated with a reduced event-free survival (log-rank p < 0.05). Early MVO was identified as the strongest independent predictor for the occurrence of the primary endpoint in the multivariable Cox regression analysis adjusting for age, ejection fraction and infarct size (hazard ratio: 2.79, 95%-CI 1.25-6.25, p = 0.012). Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.
91 citations
TL;DR: The LVGFI was a powerful predictor of incident HF, hard CV events, and a composite end point, including all events in this multiethnic cohort, and had a significant independent predictive value in the multivariable models for all CV event categories.
Abstract: Left ventricular (LV) function is generally assessed independent of structural remodeling and vice versa. The purpose of this study was to evaluate a novel LV global function index (LVGFI) that integrates LV structure with global function and to assess its predictive value for cardiovascular (CV) events throughout adult life in a multiethnic population of men and women without history of CV diseases at baseline. A total of 5004 participants in the Multi-Ethnic Study of Atherosclerosis underwent a cardiac magnetic resonance study and were followed up for a median of 7.2 years. The LVGFI by cardiac magnetic resonance was defined by the ratio of stroke volume divided by LV total volume defined as the sum of mean LV cavity and myocardial volumes. Cox proportional hazard models were constructed to predict the end points of heart failure, hard CV events, and a combined end point of all CV events after adjustment for established risk factors, calcium score, and biomarkers. A total of 579 (11.6%) CV events were observed during the follow-up period. In adjusted models, the end points of heart failure, hard CV events, and all events were all significantly associated with LVGFI (heart failure, hazard ratio=0.64, P<0.0001; hard CV events, hazard ratio=0.79, P=0.007; all events, hazard ratio=0.79, P<0.0001). LVGFI had a significant independent predictive value in the multivariable models for all CV event categories. The LVGFI was a powerful predictor of incident HF, hard CV events, and a composite end point, including all events in this multiethnic cohort.
65 citations