Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Abstract

IntroductionLeft ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).Material and methodsEighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.ResultsAt initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. –11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR– group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (–15.58 ±8.9% vs. –25.53 ±8.8%, p < 0.001; –15.02 ±5.6 vs. –19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (–8.7 ±5.8% vs. –13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR– group. According to ROC analysis, circumferential apical strain > –15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.ConclusionsOur results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients’ follow-up.

Two‐Dimensional Speckle Tracking Echocardiography Prognostic Parameters in Patients after Acute Myocardial Infarction

“…Several studies showed that most types of deformation assessed in STE during early phase of AMI reveal different degree impairment, which provide predictive value in determining the final infarct transmurality and size, segmental viability and finally LVR suggesting a higher risk of cardiovascular complications . However, data on predictive value for clinical endpoints is limited.…”

“…The major findings of our study were that longitudinal strain parameters measured soon (3 and 30 days) after the successful reperfusion in AMI and LVR assessed 90 days after the AMI were the Several studies showed that most types of deformation assessed in STE during early phase of AMI reveal different degree impairment, which provide predictive value in determining the final infarct transmurality and size, segmental viability and finally LVR suggesting a higher risk of cardiovascular complications. [8][9][10][11][12][13][14][15][16] However, data on predictive value for clinical endpoints is limited. Woo et al 17 showed that global longitudinal strain (GLS) obtained both before and 3 days after PCI in 98 patients with first STEMI is associated with all-cause mortality and unplanned hospitalization due to worsening of congestive heart failure.…”

Strain Imaging

“…Several studies have shown that the final infarct, size, viability, and LV remodeling can be predicted by utilization of 2D STE deformation analysis during acute myocardial infarction, suggesting a higher risk of cardiovascular complications. [35][36][37][38][39][40][41][42][43] However, data on predictive value for clinical endpoints are limited.…”

Left ventricular remodeling in patients with right ventricular myocardial infarction

“…Данные факты опре-деляют течение острого периода ИМ. Комплекс ком-пенсаторных изменений сердца, затрагивающих его раз-меры, геометрию и функции, объясняется как постин-фарктное ремоделирование [5][6][7]. Последнее опре-деляет прогноз позднего восстановительного периода.…”

“…Рациональная Фармакотерапия в Кардиологии 2015;11 (6) Ремоделирование левого желудочка при инфаркте миокарда правого желудочка…”