J Cardiovasc Ultrasound.  2016 Jun;24(2):128-134. 10.4250/jcu.2016.24.2.128.

Echocardiographic Predictors for Left Ventricular Remodeling after Acute ST Elevation Myocardial Infarction with Low Risk Group: Speckle Tracking Analysis

• Na HM
• Cho GY
• Lee JM
• Cha MJ
• Yoon YE
• Lee SP
• Kim HK
• Kim YJ
• Sohn DW

• KMID: 2308702
• DOI: http://doi.org/10.4250/jcu.2016.24.2.128

Abstract

BACKGROUND
We sought to assess echocardiographic predictors of left ventricular (LV) adverse remodeling after successfully reperfused acute ST elevation myocardial infarction (STEMI). LV remodeling is commonly found in STEMI patients and it may suggest adverse outcome in acute myocardial infarction. We sought to identify whether 2D strain and torsion be independent parameters for prediction of LV adverse remodeling.
METHODS
We investigated 208 patients with low-risk STEMI patients who had follow up echocardiography at 6 or more months. After clinical assessments, all patients received revascularization according to current guideline. LV remodeling was defined as > 20% increase in end-diastolic volume (EDV) at follow up.
RESULTS
During the follow-up (11.9 ± 5.3 months), 53 patients (25.5%) showed LV remodeling. In univariate analysis, EDV, end-systolic volume, deceleration time (DT), CK-MB, and global longitudinal strain (GLS) were associated with LV remodeling. In multivariate analysis, EDV [hazard ratio (HR): 0.922, 95% confidence interval (CI): 0.897-0.948, p< 0.001], GLS (HR: 0.842, 95% CI: 0.728-0.974, p = 0.020), DT (HR: 0.989, 95% CI: 0.980-0.998, p = 0.023) and CK-MB (HR: 1.003, 95% CI: 1.000-1.005, p = 0.033) independently predicted LV remodeling. However, global circumferential strain, net twist, and twist or untwist rate were not associated with remodeling.
CONCLUSION
Of various parameters of speckle strain, only GLS predicted adverse remodeling in STEMI patients.

Keyword

Acute myocardial infarction; Strain; Remodeling

MeSH Terms

Deceleration
Echocardiography*
Follow-Up Studies
Humans
Multivariate Analysis
Myocardial Infarction*
Ventricular Remodeling*

Reference

1. Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, Portnay EL, Marshalko SJ, Radford MJ, Krumholz HM. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol. 2003; 42:736–742.

2. Thune JJ, Køber L, Pfeffer MA, Skali H, Anavekar NS, Bourgoun M, Ghali JK, Arnold JM, Velazquez EJ, Solomon SD. Comparison of regional versus global assessment of left ventricular function in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction: the valsartan in acute myocardial infarction echocardiographic study. J Am Soc Echocardiogr. 2006; 19:1462–1465.

3. Burns RJ, Gibbons RJ, Yi Q, Roberts RS, Miller TD, Schaer GL, Anderson JL, Yusuf S;. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. J Am Coll Cardiol. 2002; 39:30–36.

4. McDermott MM, Feinglass J, Lee PI, Mehta S, Schmitt B, Lefevre F, Gheorghiade M. Systolic function, readmission rates, and survival among consecutively hospitalized patients with congestive heart failure. Am Heart J. 1997; 134:728–736.

5. Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J. 2006; 151:419–425.

6. Thomas JD, Popović ZB. Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol. 2006; 48:2012–2025.

7. Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation. 1993; 87:755–763.

8. Shin SH, Hung CL, Uno H, Hassanein AH, Verma A, Bourgoun M, Køber L, Ghali JK, Velazquez EJ, Califf RM, Pfeffer MA, Solomon SD;. VALIANT) Investigators. Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation. 2010; 121:1096–1103.

9. Sveälv BG, Olofsson EL, Andersson B. Ventricular long-axis function is of major importance for long-term survival in patients with heart failure. Heart. 2008; 94:284–289.

10. St John Sutton M, Lee D, Rouleau JL, Goldman S, Plappert T, Braunwald E, Pfeffer MA. Left ventricular remodeling and ventricular arrhythmias after myocardial infarction. Circulation. 2003; 107:2577–2582.

11. Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990; 81:1161–1172.

12. Langeland S, D’hooge J, Wouters PF, Leather HA, Claus P, Bijnens B, Sutherland GR. Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle. Circulation. 2005; 112:2157–2162.

13. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, Kaluski E, Krakover R, Vered Z. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr. 2004; 17:1021–1029.

14. Notomi Y, Lysyansky P, Setser RM, Shiota T, Popović ZB, Martin-Miklovic MG, Weaver JA, Oryszak SJ, Greenberg NL, White RD, Thomas JD. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardiol. 2005; 45:2034–2041.

15. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, Støylen A, Ihlen H, Lima JA, Smiseth OA, Slørdahl SA. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol. 2006; 47:789–793.

16. Hanekom L, Jenkins C, Jeffries L, Case C, Mundy J, Hawley C, Marwick TH. Incremental value of strain rate analysis as an adjunct to wall-motion scoring for assessment of myocardial viability by dobutamine echocardiography: a follow-up study after revascularization. Circulation. 2005; 112:3892–3900.

17. Hung CL, Verma A, Uno H, Shin SH, Bourgoun M, Hassanein AH, McMurray JJ, Velazquez EJ, Kober L, Pfeffer MA, Solomon SD;. Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction. J Am Coll Cardiol. 2010; 56:1812–1822.

18. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortalityfrom global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009; 2:356–364.

19. Park YH, Kang SJ, Song JK, Lee EY, Song JM, Kang DH, Kim YH, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Prognostic value of longitudinal strain after primary reperfusion therapy in patients with anterior-wall acute myocardial infarction. J Am Soc Echocardiogr. 2008; 21:262–267.

20. Lacalzada J, de la Rosa A, Izquierdo MM, Jiménez JJ, Iribarren JL, García-González MJ, López BM, Duque MA, Barragán A, Hernández C, Carrillo-Pérez M, Laynez I. Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 2015; 31:575–584.

21. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J. 2008; 29:1283–1289.

22. Nucifora G, Marsan NA, Bertini M, Delgado V, Siebelink HM, van Werkhoven JM, Scholte AJ, Schalij MJ, van der Wall EE, Holman ER, Bax JJ. Reduced left ventricular torsion early after myocardial infarction is related to left ventricular remodeling. Circ Cardiovasc Imaging. 2010; 3:433–442.

23. Bochenek T, Wita K, Tabor Z, Grabka M, Krzych Ł, Wróbel W, Berger-Kucza A, Elżbieciak M, Doruchowska A, Gluza MT. Value of speckle-tracking echocardiography for prediction of left ventricular remodeling in patients with ST-elevation myocardial infarction treated by primary percutaneous intervention. J Am Soc Echocardiogr. 2011; 24:1342–1348.

24. Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ. Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol. 2009; 54:618–624.

25. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977; 56:786–794.

26. Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T. The functional role of longitudinal, circumferential, and radial myocardial deformation for regulating the early impairment of left ventricular contraction and relaxation in patients with cardiovascular risk factors: a study with two-dimensional strain imaging. J Am Soc Echocardiogr. 2008; 21:1138–1144.

27. Reant P, Labrousse L, Lafitte S, Bordachar P, Pillois X, Tariosse L, Bonoron-Adele S, Padois P, Deville C, Roudaut R, Dos Santos P. Experimental validation of circumferential, longitudinal, and radial 2-dimensional strain during dobutamine stress echocardiography in ischemic conditions. J Am Coll Cardiol. 2008; 51:149–157.

28. Abate E, Hoogslag GE, Leong DP, Bertini M, Antoni ML, Nucifora G, Joyce E, Holman ER, Siebelink HM, Schalij MJ, Bax JJ, Delgado V, Ajmone Marsan N. Association between multilayer left ventricular rotational mechanics and the development of left ventricular remodeling after acute myocardial infarction. J Am Soc Echocardiogr. 2014; 27:239–248.

29. Choi JO, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Park SM, Yoo NJ, Choi JH, Kim HK, Cho GY, Lee MR, Park JS, Shim CY, Kim DH, Shin DH, Shin GJ, Shin SH, Kim KH, Park JH, Lee SY, Kim WS, Park SW. Normal echocardiographic measurements in a Korean population study: part I. Cardiac chamber and great artery evaluation. J Cardiovasc Ultrasound. 2015; 23:158–172.

30. Seo Y, Ishizu T, Aonuma K. Current status of 3-dimensional speckle tracking echocardiography: a review from our experiences. J Cardiovasc Ultrasound. 2014; 22:49–57.