Comparison of regional versus global assessment of left ventricular function in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction: the valsartan in acute myocardial infarction echocardiographic study.
BACKGROUND
Left ventricular (LV) ejection fraction (EF) and wall-motion index (WMI) have both been shown to be independent predictors of outcome after myocardial infarction (MI).


OBJECTIVE
We sought to determine whether these two measurements of LV systolic function provide similar or complementary information about prognosis after MI.


METHODS
Echocardiography was performed in 610 patients with LV dysfunction, heart failure, or both after MI enrolled in the Valsartan in Acute MI trial. LVEF was estimated by biplane Simpson's rule, and WMI was assessed using a 16-segment model in 502 patients with echocardiograms of sufficient quality for wall-motion assessment.


RESULTS
Both LVEF and WMI were independent predictors of adverse outcome after MI. LVEF conferred no additional prognostic information in multivariable analysis including WMI (P = .39) or number of affected segments (P = .53), whereas WMI (P = .02) and total number of affected segments (P = .006) remained significant even when adjusting for LVEF.


CONCLUSIONS
Assessment of regional dysfunction by WMI or the number of affected segments has slightly more prognostic value than LVEF in patients with LV dysfunction, heart failure, or both after MI. Regional assessment might be a more sensitive predictor of outcome than global assessment in patients with acute MI.
Thune
Jens Jakob
JJ
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Køber
Lars
L
Pfeffer
Marc A
MA
Skali
Hicham
H
Anavekar
Nagesh S
NS
Bourgoun
Mikhail
M
Ghali
Jalal K
JK
Arnold
J Malcolm O
JM
Velazquez
Eric J
EJ
Solomon
Scott D
SD
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control
D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine