Usefulness of Two-Dimensional Longitudinal Strain Pattern to Predict Left Ventricular Recovery and In-Hospital Complications after Acute Anterior Myocardial Infarction Treated Successfully by Primary Angioplasty - 03/11/15
, Shirley Abouth, MD, Jérome Clerc, MD, Frederic Elmkies, MD, Sonia Martis, MD, Anne Luycx-Bore, MD, Jacques Boulanger, MDAbstract |
Background |
The aim of this study was to test the usefulness of two-dimensional longitudinal strain pattern in segments with wall motion abnormalities to predict left ventricular recovery and in-hospital cardiac events as well as coronary microvascular impairment (CMI) in patients with recent acute anterior myocardial infarction.
Methods |
Forty-nine consecutive patients with acute myocardial infarction (mean age, 59 ± 13 years) treated successfully with primary coronary angioplasty prospectively underwent transthoracic Doppler echocardiography 24 hours after angioplasty and during follow-up (6 months). A two-dimensional strain analysis, including measurement of the duration of systolic lengthening expressed as a percentage of systolic duration (SL % duration), the lengthening-to-shortening ratio, the postsystolic shortening index in segments with wall motion abnormalities, and global longitudinal strain and left anterior descending coronary artery territory strain, was performed. Cardiac events were defined as a composite of death, reinfarction, and heart failure. CMI was assessed noninvasively by transthoracic Doppler left anterior descending coronary artery investigation <24 h after angioplasty and was defined as coronary flow velocity reserve < 1.7 and/or a no-reflow pattern (mean coronary flow velocity reserve, 1.8 ± 0.6 in the whole group).
Results |
At the segmental level, SL % duration, lengthening-to-shortening ratio, and postsystolic shortening index were correlated with recovery (defined as normalization of wall motion abnormalities), whereas in multivariate analysis, only SL % duration independently predicted recovery (threshold level, 40%; area under the curve, 0.76; P < .01). At the patient level, in univariate analysis, SL % duration, global longitudinal strain, left anterior descending coronary artery territory strain, and troponin peak were correlated with recovery (defined as an absolute improvement of left ventricular ejection fraction of >5%). In multivariate analysis, SL % duration was independently related to recovery (area under the curve, 0.78; P < .01). Furthermore, SL % duration was independently linked to cardiac events (n = 13) and CMI (n = 24) (P < .01 for all).
Conclusions |
In patients with AMI treated by primary angioplasty, two-dimensional strain predicts left ventricular recovery independently of more traditional parameters and is independently linked to cardiac events and CMI.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Identification of LV recovery after myocardial infarction is important but challenging. |
• | Longitudinal systolic lengthening duration is an independent predictor of segmental as well as global LV recovery after anterior myocardial infarction treated successfully by primary angioplasty. |
• | Longitudinal systolic lengthening duration is independently linked to in-hospital events driven by heart failure and to coronary microvascular integrity assessed noninvasively by the coronary flow reserve and the no-reflow pattern. |
Keywords : Longitudinal strain, Systolic lengthening, Myocardial infarction, Heart failure, Coronary flow reserve
Abbreviations : AMI, AUC, CFVR, CMI, GLS, LAD, LV, LVEF, MRI, OR, SL, SL % duration, 2DS, WMA, WMSI
Plan
Vol 28 - N° 11
P. 1366-1375 - novembre 2015 Retour au numéro
Article précédent
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