The Value of Three-Dimensional Speckle-Tracking Echocardiography in the Prediction of Cardiovascular Events in Patients with Hypertension Complicated by Acute Myocardial Infarction: A Long-Term Follow-Up Study

Figures & data

Figure 1 Kaplan–Meier survival analysis curve for patients with hypertension accompanied by AMI. The follow-up time was (41.27±20.45) months, and 20 patients had recurrent cardiovascular events during the follow-up period.

Table 1 Demographic and Clinical Characteristics of Patients in Group NCE and Group RCE

Parameter	Group NCE (n=42)	Group RCE (n=20)	t/Z/χ^2	P
Age (years)	54.14±11.59	57.30±10.40	−1.035	0.305
Male gender, n (%)	35 (83.3%)	19 (95.0%)	0.767	0.381
High (cm)	167.40±5.08	166.00±4.23	1.072	0.288
Weight (Kg)	68.45±9.06	63.95±9.39	1.807	0.076
BMI (Kg/m2)	24.40±2.79	23.15±2.92	1.614	0.112
Heart rate (beats/min)	71.33±9.35	68.40±6.07	1.481	0.144
Systolic blood pressure (mm Hg)	134.05±17.51	130.15±14.82	0.859	0.394
Diastolic blood pressure (mm Hg)	75.17±7.90	76.55±7.67	−0.650	0.518
Total cholesterol (mmol/l)	3.73 (2.83, 4.75)	2.74 (2.19, 1.83)	−1.875	0.061
Plasma triglycerides (mmol/l)	1.45 (1.20, 1.70)	1.55 (1.35, 1.87)	−1.212	0.225
Low-density lipoprotein (mmol/l)	1.28±0.54	1.31±0.65	−0.183	0.855
Creatine Kinase Isoenzyme-II (ng/mL)	55.16 (2.00, 138.80)	11.73 (4.78, 72.35)	−1.204	0.233
Myoglobin (ng/mL)	56.20 (30.80, 405.20)	41.85 (19.23, 158.05)	−1.604	0.112
Troponin-I (ng/mL)	14.87 (0.97, 38.42)	23.29 (6.81, 87.71)	−0.345	0.737
B-type natriuretic peptide (ng/mL)	397 (109, 942)	600 (235.25, 996.75)	−1.086	0.288
Culprit lesion on CAG LAD	17 (40.5%)	9 (45.0%)	0.138	0.972
Culprit lesion on CAG RCA	12 (28.6%)	5 (25.0%)
Culprit lesion on CAG CX	2 (4.8%)	1 (5.0%)
Two or more culprit lesion	11 (26.2%)	5 (25.0%)

Notes: Data presented as mean ± standard deviation, median and interquartile range or n (%); Group NCE patients without recurrent cardiovascular event, Group RCE patients with recurrent cardiovascular event.

Abbreviations: CAG, coronary angiography; LAD, left anterior descending coronary artery; RCA, right coronary artery; CX, circumflex coronary artery.

Table 2 Echocardiographic Parameters of Patients in Group NCE and Group RCE

Parameter	Group NCE (n=42)	Group RCE (n=20)	t	P
Initial echocardiographic findings
LV end-diastolic volume (mL)	134.79±13.28	135.85±14.45	−0.287	0.775
LV end-systolic volume (mL)	70.67±7.27	72.60±6.64	−1.006	0.319
LV ejection fraction (%)	46.48±3.41	47.00±3.58	−0.556	0.580
3D LV end-diastolic volume (mL)	144.76±17.19	140.95±17.97	0.805	0.424
3D LV end-systolic volume (mL)	75.21±8.48	79.35±8.15	−1.817	0.074
3D LV ejection fraction (%)	44.24±2.77	44.70±2.34	0.644	0.522
3D Global longitudinal strain (%)	−7.24±2.13	−8.25±2.27	1.714	0.092
3D Global circumferential strain (%)	−8.67±2.87	−7.65±2.83	−1.310	0.195
3D Global radial strain (%)	23.00±6.11	22.05±7.38	0.537	0.593
3D Global area strain (%)	−15.31±5.29	−14.35±4.33	−0.706	0.483
One week after PCI
LV end-diastolic volume (mL)	131.64±8.91	135.20±9.13	−1.458	0.150
LV end-systolic volume (mL)	65.29±7.13*	68.10±8.05*	−1.394	0.169
LV ejection fraction (%)	49.57±3.25*	50.85±3.23*	−1.451	0.152
3D LV end-diastolic volume (mL)	139.45±11.31	141.95±12.81	−0.779	0.439
3D LV end-systolic volume (mL)	74.17±10.63	77.40±6.55	−1.471	0.147
3D LV ejection fraction (%)	47.38±2.76*	46.05±2.40*	1.850	0.069
3D Global longitudinal strain (%)	−7.36±2.52	−8.30±2.56	1.372	0.175
3D Global circumferential strain (%)	−8.71±2.96	−7.75±2.40	−1.270	0.209
3D Global radial strain (%)	21.50±6.70	21.85±5.68	−0.203	0.840
3D Global area strain (%)	−15.05±4.22	−14.75±6.32	−0.191	0.850
One month after PCI
LV end-diastolic volume (mL)	131.20±9.77	137.05±9.26	−2.240	0.029
LV end-systolic volume (mL)	60.31±6.34*^#	64.00±6.30*	−2.147	0.036
LV ejection fraction (%)	53.62±3.42*^#	53.50±3.27*^#	0.130	0.897
3D LV end-diastolic volume (mL)	137.83±11.12	146.15±16.34	−2.354	0.022
3D LV end-systolic volume (mL)	66.36±6.55*^#	70.60±7.69*^#	−2.254	0.028
3D LV ejection fraction (%)	50.21±3.47*^#	50.95±2.78*^#	−0.829	0.410
3D Global longitudinal strain (%)	−12.81±2.48*^#	−10.55±2.21*^#	−3.466	0.001
3D Global circumferential strain (%)	−11.90±3.33*^#	−10.95±2.95*^#	1.093	0.279
3D Global radial strain (%)	27.40±5.71*^#	26.40±5.67	0.649	0.519
3D Global area strain (%)	−21.95±3.59*^#	−19.45±3.19*^#	−2.657	0.010

Notes: Data given as the mean± SD; Group NCE patients without recurrent cardiovascular event, Group RCE patients with recurrent cardiovascular event; *p value ≤ 0.05 versus Initial echocardiographic findings, ^#p value ≤ 0.05 versus One week after PCI. There was a strong correlation between LV end-diastolic volume and 3D LV end-diastolic volume with statistical significance (r=0.89, P<0.01).

Abbreviations: LV, left ventricle; PCI, percutaneous coronary intervention.

Figure 2 Comparison of 3D strain parameters in patients with hypertension accompanied by AMI during follow-up. Group NCE patients without recurrent cardiovascular event, Group RCE patients with recurrent cardiovascular event; *p value < 0.05 versus Initial echocardiographic findings or one week after PCI.

Abbreviations: LV, left ventricle; PCI, percutaneous coronary intervention; 3D-GLS, 3D Global longitudinal strain; 3D-GCS, 3D Global circumferential strain; 3D-GAS, 3D Global radial strain; 3D-GAS, 3D Global area strain.

Table 3 Univariate and Multivariate Cox Risk Regression Models to Analyze Risk Factors for Recurring Cardiovascular Events in Patients with Hypertension Accompanied by AMI

Variable	Univariate Analysis			Multivariate Analysis
	HR	95% CI	P	HR	95% CI	P
LV end-diastolic volume (mL)	1.053	(1.003, 1.106)	0.039	–	–	–
3D LV end-diastolic volume (mL)	1.038	(1.004, 1.072)	0.027	–	–	–
3D LV end-systolic volume (mL)	1.074	(1.010, 1.143)	0.023	–	–	–
3D Global longitudinal strain (%)	1.381	(1.130, 1.689)	0.002	1.481	(1.202, 1.824)	<0.001
3D Global area strain (%)	1.188	(1.044, 1.351)	0.009	1.254	(1.093, 1.440)	0.001

Abbreviations: LV, left ventricle; 3D, three-dimensional; HR, hazard ratio; CI, confidence interval.

Figure 3 ROC curves of 3D Global longitudinal strain, 3D Global area strain for predicting recurrent cardiovascular events in patients with hypertension accompanied by AMI.

Table 4 Intar-Observer and Inter-Observer Variability of 3D Strain Parameters (n = 22)

	Intra-Observer (n=11) ICC	95% CI	Inter-Observer (n=11) ICC	95% CI
3D Global longitudinal strain (%)	0.993	0.974–0.998	0.945	0.796–0.986
3D Global circumferential strain (%)	0.992	0.967–0.998	0.978	0.913–0.994
3D Global radial strain (%)	0.980	0.924–0.995	0.855	0.572–0.963
3D Global area strain (%)	0.991	0.960–0.998	0.904	0.669–0.979

Abbreviations: 3D, three-dimensional; ICC, interclass coefficient; CI, confidence interval.