Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Imaging
Prognostic Significance of a Combination of QRS Score and E/e′ Obtained 2 Weeks After the Onset of ST-Elevation Myocardial Infarction
Noriaki Iwahashi, Masaomi Gohbara, Jin Kirigaya, Takeru Abe, Mutsuo Horii, Hironori Takahashi, Masami Kosuge, Yohei Hanajima, Eiichi Akiyama, Kozo Okada, Yasushi Matsuzawa, Nobuhiko Maejima, Kiyoshi Hibi, Toshiaki Ebina, Kouichi Tamura, Kazuo Kimura
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Keywords: Prognosis, QRS score, ST-elevation myocardial infarction (STEMI), Tissue Doppler imaging
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2020 Volume 84 Issue 11 Pages 1965-1973

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Abstract

Background:The early mitral inflow velocity to mitral early diastolic velocity ratio (E/e′) and electrocardiogram (ECG) determination of QRS score are useful for risk stratification in patients with ST-elevation myocardial infarction (STEMI).

Methods and Results:In this study, 420 consecutive patients (357 male; mean [±SD] age 63.6±12.2 years) with first-time STEMI who successfully underwent primary percutaneous coronary intervention within 12 h of symptom onset were followed-up for 5 years (median follow-up 67 months). Echocardiography, ECG, and blood samples were obtained 2 weeks after onset. Infarct size was estimated by the QRS score after 2 weeks (QRS-2wks) and creatine phosphokinase-MB concentrations (peak and area under the curve). The primary endpoint was death from cardiac causes or rehospitalization for heart failure (HF). During follow-up, 21 patients died of cardiac causes and 62 had HF. Multivariate Cox proportional hazard analysis showed that mean E/e′ (hazard ratio [HR] 1.152; 95% confidence interval [CI] 1.088–1.215; P<0.0001), QRS-2wks (HR 1.153; 95% CI 1.057–1.254; P<0.0001), and hypertension (HR 1.702; 95% CI 1.040–2.888; P=0.03) were independent predictors of the primary endpoint. Kaplan-Meier curve analysis showed that patients with QRS-2wks >4 and mean E/e′ >14 were at an extremely high risk of cardiac death or HF (log rank, χ2=116.3, P<0.0001).

Conclusions:In patients with STEMI, a combination of QRS-2wks and mean E/e′ was a simple but useful predictor of cardiac death and HF.

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© 2020 THE JAPANESE CIRCULATION SOCIETY

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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Japanese Circulation Journal

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