Post-systolic shortening predicts heart failure following acute coronary syndrome

Background: Post-systolic shortening (PSS) is a novel echocardiographic marker of myocardial dysfunction. Our objective was to assess the prognostic value of PSS in patients following acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: A total of 428 patients hospitalized for ACS (mean age 64 +/- 12 years, male 73%) underwent speckle tracking echocardiography following treatment with PCI (median 2 days). The individual endpoints were heart failure (HI), myocardial infarction (MI) and all-cause death. We excluded known HI. Presence of PSS was defined as post-systolic displacement >= 20% of maximum strain in one cardiac cycle. The post-systolic index (PSI) was defined as (100 x [maximum-strain cardiac cycle peak-systolic strain])](maximum-strain cardiac cycle)]. Results: During median follow-up of 3.7 years (1QR 0.3, 5.2),155 patients (36%) experienced HI', 52 (12%) had MI and 87 (20%) died from all causes. Patients experiencing HF had more walls displaying PSS (3.2 vs. 1.9 walls) and higher PSI (22% vs. 12%) (P < 0.001 both). In Cox proportional hazards models adjusted for baseline characteristics, invasive and echocardiographic measurements, the risk of HF increased incrementally with increasing number of walls with P55 (HR 128 95%Cl 1.12-1A6, P < 0.001 per 1 increase in walls with P55). The PSI remained an independent predictor of HF after adjustment (HR 1.61 95 CI 121-2.12, P = 0.001 per 1% increase). In the same adjusted models, MI and all-cause death were not significantly associated with PSS. Conclusion: Presence of P55 provides novel and independent prognostic information regarding the risk of future HF in patients with ACS following PCI. (C) 2018 Elsevier B.V. All rights reserved.