Prediction of adverse outcomes in the long-term follow-up period in patients with chronic heart failure who have suffered a myocardial infarction

Aim – to determine the prognostic significance of global longitudinal strain of the left ventricle (GLS) and soluble stimulating growth factor (sST2) in patients with chronic heart failure (CHF) after myocardial infarction (MI) in the annual follow-up period.

Material and methods. The study included 96 patients with CHF who were hospitalized with acute MI. All subjects underwent speckle-tracking echocardiography and determination of concentrations of sST2, vascular endothelial growth factor (VEGF), N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). After 12 months patients were assessed for cases of stroke, recurrent myocardial infarction, hospitalization for unstable angina or decompensation of CHF, and cardiovascular death, forming a combined endpoint (CEP).

Results. The development of CEP was registered in 44 (45.8%) patients with initially lower left ventricular ejection fraction and GLS, higher left ventricular myocardial mass index, index of impaired local contractility, basal diameter of the excretory tract, as well as a higher score on the Syntax scale and concentrations of CRP, NT-proBNP and sST2. During the ROC-analysis for the development of CEP, optimal thresholds for sST2 and NT proBNP were determined, which were 36.1 ng/ml and 427 pg/ml, respectively. The multifactorial analysis made it possible to develop a mathematical model for predicting adverse outcomes within 12 months after MI, which included such indicators as GLS – odds ratio (OR) 0.51 (0.39; 0.72), the number of points on the Syntax scale – OR 3.05 (2.2; 6.8), concentrations of NTproBNP – OR 2.9 (1.45; 5.1) and sST2 – OR 3.3 (1.65; 7.51).

Conclusion. The developed prognostic model includes factors reflecting various links in the pathogenesis of CHF, which provides an integrated approach to assessing the risks of recurrent cardiovascular events after MI.