P963 Heart failure development in patients with preserved ejection fraction after STEMI: how frequent is It and can we predict it?
Authors: Trifunovic D , Krljanac G , Asanin M , Savic-Spasic L , Aleksandric S , Dudic J , Cucic L , Sulovic V , Mrdovic I 
Published: January 2020

Data regarding heart failure (HF) development among patients with preserved EF (≥50%) after STEMI are spare. Accurate and early identification of patients at risk might allow timely application of modern therapy targeted for HFpEF.

Aim

the current study is a sub-study of PREDICT-VT (NCT03263949). Its aim was to determine the incidence and predictors of HFpEF development in STEMI patients treated by pPCI.

Methods

in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done and included multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec) and rotational LV mechanics. LV index of post systolic shortening for longitudinal strain (PSS LS) and for circumferential strain (PSS CS) were calculated as average of PSS over 18 LV segments. LV diastolic function was assessed according to the current ESC guidelines.

Results

From 264 patients enrolled in PREDICT-VT study, until now 195 patients completed one-year follow and among them 87 pts (46 %) had EF≥50%. From those patients during one-year follow-up 30 pts (30.3 %) develop HF: 3 pts NYHA class 3/ 4 and 27 pts NYHA class 2. Patients who developed HF (Group HF, n = 30) were older (62 ± 7 vs55 ± 11, p = 0.002), had lower E/A ratio (0.77 ± 0.25 vs 0.94 ± 0.32, p = 0.014), more commonly altered LV diastolic function (83 vs 60%, p = 0.028) compared with pts who remained in NYHA class I (Group none-HF, n = 57). There were no significant differences in LVEF, MI localisation, nor in WMSI between groups. Longitudinal and circumferential myocardial deformations did not differ significantly, except for more pronounced PSS LS on epicardial level in Group –HF (11.5 ±7.5 vs 8.3 ± 7.7%, p = 0.073). Rotation mechanic analysis revealed that Group –HF had increased (14.08 ± 5.5 vs 12.5 ± 5.4°, p = 0.202), but delayed twist (350 ± 69 vs 327 ± 68 ms, p = 0.139) with reduced magnitude of peak untwisting velocities (-88.58 ±34.16 vs -95.20 ± 39.75°/sec, p = 0.488). However, only statistically significant difference was increased magnitude of untwisting velocity during late diastole (-57.53 ± 30.61 vs -42.88 ± 27.78, p = 0.029). Significant univariate predictors of HF development were: older age (Exp (B)=1.08, CI 1.027-1.139, p = 0.03), E/A ratio (Exp (B) =0.130, p = 0.018, 95%CI 0.024-0.700), female gender (Exp (B)=2.933, 95% CI 1.163 -7.397, p = 0.023) and late-diastolic untwisting velocity (Exp (B)=0.983, 95%CI 0.967-0.999, p = 0.033). However, in multivariable analysis only older age (Exp B= 1.09, 95% CI 1.028-1.155, p = 0.004) and female gender (Exp B= 2.80, 95% CI 1.01-7.708, p = 0.046) remained significant predictors.

Conclusion

HF after STEMI in patients with preserved EF is not rare and probably substantially contributes to the total incidence HF after STEMI. However, its prediction remained challenging, with female gender and older age confirmed as its significant determinants.