Predictive value of myocardial strain on myocardial infarction size by cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction with preserved left ventricular ejection fraction

Abstract

Background: The correlation between myocardial strain and infraction size by cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction (STEMI) with preserved left ventricular ejection fraction (LVEF) is not clear.Objective: To investigate the correlation between myocardial strain and myocardial infarction size in patients of acute STEMI with preserved LVEF.Materials and Methods: A retrospective study was conducted to assess 31 patients with acute ST-segment elevation myocardial infarction (STEMI)after primary percutaneous coronary intervention (PCI) who received cardiac magnetic resonance (CMR) imaging during hospitalization at the Central Hospital of Shandong First Medical University from 2019 to 2022 and whose echocardiography indicated preserved LVEF (LVEF≥50%). The control group consisted of 21 healthy adults who underwent CMR during the same period. We compared the CMR characteristics, global and segmental strain between the two groups. Furthermore, the correlation between the global strain and the segmental strain of the left ventricle and late gadolinium enhancement (LGE) were evaluated.Results: Compared with healthy controls, the left ventricular ejection fraction (LVEF) of STEMI patients with preserved LVEF was significantly decreased (p < 0.05). Moreover, the global radial strain (GRS) (24.09% [IQR:17.88–29.60%] vs. 39.56% [IQR:29.19–42.20%], p < 0.05), global circumferential strain (GCS) [−14.66% (IQR: 17.91–11.56%) vs. −19.26% (IQR: 21.03–17.73%), p < 0.05], and global longitudinal strains (GLS) (−8.88 ± 2.25% vs. −13.46 ± 2.63%, p < 0.05) were damaged in patients. Furthermore, GCS and GLS were associated with LGE size (%left ventricle) (GCS: r = 0.58, p < 0.05; GLS: r = 0.37, p < 0.05). In the multivariate model, we found that LGE size was significantly associated with GCS (β coefficient = 2.110, p = 0.016) but was not associated with GLS (β coefficient = −0.102, p = 0.900) and LVEF (β coefficient = 0.227, p = 0.354). The receiver operating characteristic (ROC) results showed that GCS emerged as the strongest LGE size (LGE >25%) prognosticator among strain parameters (AUC: 0.836 [95% CI, 0.692—0.981], sensitivity: 91%, specificity: 80%) and was significantly better (p = 0.001) than GLS [AUC: 0.761 (95% CI, 0.583—0.939), sensitivity: 64%, specificity: 85%] and LVEF [AUC: 0.673 (95% CI, 0.469—0.877), sensitivity: 73%, specificity: 70%].Conclusion: Among STEMI patients with preserved LVEF after PCI, CMR-FT-derived GCS had superior diagnostic accuracy than GLS and LVEF in predicting myocardial infarction size.

Number of segments with motion abnormalities is better correlated with infarct size in acute myocardial infarction

“…MIS is an established determinant of adverse clinical outcomes after acute MI (AMI), such as cardiac death, recurrent myocardial infarct, life-threatening arrhythmias, etc [11][12][13][14], and its stratification is of prognostic importance for post-AMI patients. Previous studies observed that myocardial strain and myocardial work indices generated from STE were associated with infarct sizes [1][2][3][4][5][6]. Accordingly, they were used to predict MIS.…”

“…Speckle-tracking echocardiography (STE) is a noninvasive tool that enables visualization of the global and segmental wall motion abnormality after ST-segment elevation myocardial infarction (STEMI), which can not only provide quantitative evaluation by strain and myocardial work indices but also provide qualitative evaluation by assigning different colors to segments with motion abnormalities (SMA) on the bull's-eye plots. Several studies have confirmed that strain and myocardial work indices are associated with myocardial infarct size (MIS) and can thus predict it [1][2][3][4][5][6]; however, there are few studies on the MIS prediction by the number of SMA of bull's-eye plots.…”

Recent Advances in Cardiac Magnetic Resonance for Imaging of Acute Myocardial Infarction

“…This demonstrated that, in patients with STEMI with preserved LVEF after PCI, CS exhibited supe-rior diagnostic accuracy in predicting the size of myocardial infarction compared to LS and LVEF. [26] Leng et al conducted a prospective multicenter study of 321 patients with STEMI to explore the association between left ventricular strain under CMR-FT and MACE. The results showed that reservoir strain (hazard ratio (HR): 0.84; 95% CI: 0.77-0.91; P < 0.001) and conduit strain (HR: 0.81; 95% CI: 0.73-0.89; P < 0.001) were independent predictors of MACE after adjustment for known risk factors.…”

“…This demonstrated that, in patients with STEMI with preserved LVEF after PCI, CS exhibited superior diagnostic accuracy in predicting the size of myocardial infarction compared to LS and LVEF. [ 26 ] Leng et al. conducted a prospective multicenter study of 321 patients with STEMI to explore the association between left ventricular strain under CMR‐FT and MACE.…”