title: Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction.
abstract: OBJECTIVE
  Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis.
  
  
  RESULTS
  We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS.
  
  
  CONCLUSIONS
  In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA Division of Epidemiology, Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Na
authors.initials: N
authors.lastname: Wang
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA Department of Health Industry Management, Kainan University, Taoyuan, Taiwan Division of Cardiovascular Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA Division of Cardiology, Department of Internal Medicine, Inha University, Incheon, South Korea.
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens Jakob
authors.initials: JJ
authors.lastname: Thune
authors.affiliation: Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Amil
authors.initials: A
authors.lastname: Shah
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D013312:Stress, Physiological / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology
keywords: Cardiovascular outcomes; Heart failure; Left ventricular dysfunction; Myocardial infarction; Regional cardiac dysfunction