Prognosis after acute coronary syndrome in relation with ventricular-arterial coupling and left ventricular strain

BackgroundThe 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 30 mmHg (V30) with long-term clinical outcomes in patients with ACS.MethodsEchocardiography was applied in 569 ACS patients followed up for > 12 months 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).ResultsThere were 57 clinical outcomes during a median follow-up of 625 days. Increased VA coupling > 1.68 (HR 2.4; 95% CI: 1.04-5.6); V30 > 107 mL (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.ConclusionsWith 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.

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