LEFT VENTRICULAR-ARTERIAL COUPLING ESTIMATED BY TRANSTHORACIC
ECHOCARDIOGRAPHY IN LATE PRESENTERS WITH ST-SEGMENT ELEVATION MYOCARDIAL
INFARCTION
Abstract
ABSTRACT INTRODUCTION There is
scarce information about the usefulness and prognostic value of left
ventriculo-arterial coupling (VAC) in the context of acute coronary
syndromes. In addition, there is a paucity of data of its use in late
presenters with STEMI (12-72 hours after symptom onset).
OBJETIVES In this retrospective study, we
investigated the association of altered VAC with in-hospital mortality
in late presenters with STEMI. Additionally, we studied the association
between VAC and multiple clinical, biochemical, echocardiographic, and
angiographic variables. METHODS 74
hemodynamically stable late presenters with STEMI were included. Mean
age was 61.7±10.7 years, 85.1% were male. Mean LVEF was 42.8±11.3 %.
VAC was estimated using transthoracic echocardiography with the
single-beat method before coronary angiography. The sample was divided
into two groups: 1) Patients with normal VAC (<1.36) and 2)
Patients with altered VAC (>1.36). A statistically
significant difference was found in the left ventricular ejection
fraction (LVEF) (44.4±10.9% vs 36.2±11%, p=0.014), and in the blood
urea nitrogen (BUN) level (19.45±8.00 mg/dL vs 25.45±10.40 mg/dL,
p=0.02) between both groups. No statistically significant differences
were found in other variables, including in-hospital mortality.
CONCLUSION A higher VAC value was found (i.e.,
ventriculo-arterial uncoupling) in late presenters with lower LVEF and
higher BUN level. No significant differences in in-hospital mortality
were found. VAC may be used with point-of-care ultrasound as an
approximate estimation of left ventricular systolic function in patients
with late presentation STEMI, as it correlates with LVEF but is less
operator-dependent. Larger studies are needed to confirm these
findings.
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