Pilot study to predict future cardio-vascular events by novel 3D- echocardiography Global area strain in STEMI patients managed by primary PCI

Abstract

Background Three-dimensional speckle tracking echocardiography (STE) is an ideal modality for accurate assessment of myocardial deformation, the Novel 4D-Global Area strain (GAS) is a very sensitive parameter in detection of subtle changes involving the myocardium as it encompasses both global longitudinal and global circumferential strains . Objectives To investigate the predictive value of four dimensional (4D) strain echocardiography for major adverse cardio-vascular events (MACE) in ST-elevation acute myocardial infarction (STEMI) after successful reperfusion by primary PCI. Methods 171 patients who underwent successful primary PCI were enrolled and properly examined by 2D and 4D echocardiography with 4D strain parameters evaluation then followed up all-over a year for the occurrence of Major adverse Cardiovascular Events (MACE) . Results Thirty two MACE were recorded in 170 patients who completed the follow-up period for one year, compared with those without MACE, patients with MACE had PTCA done during the index Primary PCI intervention, had multi-vessel CAD affection, higher LVEDD, higher LVESD, lower 2D- LVEF, higher WMSI, higher baseline HR, higher EDV and ESV, lower 3D- LVEF, higher 3D-GLS, 3D-GCS and 3D-GAS with lower 3D-GRS, all with p-values < 0.005. Multi-variant logistic regression analysis showed that GAS was the most powerful predictor for MACE among our study population with the best cut-off value of 3D-GAS> -17, with p-value of (0.008) OR (20.668), CI (2.227-191.827) with relative risk of adverse events of 18.205 (95% CI 6.976- 47.506 – P value < 0.001). Conclusion Our data supports the superiority of 4D strain echocardiography parameters specially GAS for prediction of adverse clinical events among patients managed by successful primary PCI .