title: Prognosis after acute coronary syndrome in relation with ventricular-arterial coupling and left ventricular strain.
abstract: BACKGROUND
  The value of modern non-invasive indices of the left ventricle (LV) and arterial system function, and their interaction for determining prognosis in contemporarily treated patients with acute coronary syndrome (ACS) is not well established. The study aimed to determine the association of ventricular-arterial (VA) coupling, LV global longitudinal peak systolic strain (GLPSS), global strain rate (GSR) and end-diastolic volume at end-diastolic pressure 30mmHg (V30) with long-term clinical outcomes in patients with ACS.
  
  
  METHODS
  Echocardiography was applied in 569 ACS patients followed up for >12months after hospitalization. Univariate Cox proportional hazard regression models adjusted to various clinical factors, including reduced LV ejection fraction <40%, were used to compare patients between the first and third tertiles of various indices of LV and arterial systems function and their interaction for the prediction of a combined end-point (defined as either stroke, myocardial infarction or death). Results are presented as hazard ratio (HR) with 95% confidence interval (CI).
  
  
  RESULTS
  There were 57 clinical outcomes during a median follow-up of 625days. Increased VA coupling >1.68 (HR 2.4; 95% CI: 1.04-5.6); V30>107mL (HR 4.5; 95% CI: 1.9-10.6), GLPSS > -12.8% (HR 2.4; 95% CI: 1.02-5.7), GSR > -0.96 1/s (HR 3.8; 95% CI: 1.6-9.1) were robustly associated with increased hazard.
  
  
  CONCLUSIONS
  With a sample of contemporarily treated ACS patients, abnormal values of non-invasive indices of LV function and their interaction with arterial system, predict adverse clinical outcomes, independently of LV ejection fraction.
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Milewska
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Minczykowski
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Krauze
authors.affiliation: Institute of Physics, University of Zielona Gora, Zielona Gora, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Piskorski
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland; Department of Psychology, University of Sydney, Sydney, NSW, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Heathers
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Szczepanik
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Banaszak
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Guzik
authors.affiliation: Department of Cardiology-Intensive Therapy, Poznan University School of Medicine, Poznan, Poland. Electronic address: awykreto@ptkardio.pl.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wykretowicz
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D015331:Cohort Studies; D004452:Echocardiography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Acute coronary syndrome; Ejection fraction; Global strain; Pressure–volume relationship; Ventricular–arterial coupling