Korean Circ J.  2019 Oct;49(10):960-972. 10.4070/kcj.2018.0421.

Usefulness of Myocardial Longitudinal Strain in Prediction of Heart Failure in Patients with Successfully Reperfused Anterior Wall ST-segment Elevation Myocardial Infarction

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea. shleemd@jbnu.ac.kr
  • 2Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.
  • 3Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LSant) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF.
METHODS
A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups.
RESULTS
In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LSant was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF.
CONCLUSIONS
GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LSant was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.

Keyword

Anterior wall myocardial infarction; Echocardiography; Heart failure; Strain

MeSH Terms

Anterior Wall Myocardial Infarction
Arteries
Echocardiography
Heart Failure*
Heart*
Humans
Multivariate Analysis
Myocardial Infarction*

Figure

  • Figure 1 A flow chart showing the number of patients excluded, the reasons for exclusion and 3 groups in this study. HF = heart failure; LAD = left anterior descending artery; PCI = percutaneous coronary intervention; RWMA = regional wall motion abnormalities; STEMI = ST-segment elevation myocardial infarction.

  • Figure 2 Measurement of GLS and LSant using two-dimensional speckle tracking echocardiography. (A-C) A region of interest is semiautomatically tracked in each of 3 apical images and software generates longitudinal strain curves for each 17 segments. (D) Note a bull's eye plot image and GLS. GLS = global longitudinal strain; LAD = left anterior descending artery; LSant = mean longitudinal strain of left anterior descending artery territory.

  • Figure 3 Bull's eye image plots in 2 contrastive cases of with ant-STEMI, the same LVEF of 48%, and single vessel disease on coronary angiography. Note the differences between (A) a 73-year-old man with GLS of −9.7% (LSant, −2.5%) who experienced in-hospital HF and (B) a 46-year-old man with GLS of −16.1% (LSant, −10.5%) without signs of HF. ant-STEMI = anterior wall ST-segment elevation myocardial infarction; GLS = global longitudinal strain; HF = congestive heart failure; LSant = mean longitudinal strain of left anterior descending artery territory; LVEF = left ventricular ejection fraction.

  • Figure 4 ROC curves testing and comparing values of GLS and LSant versus LVEF and NT-proBNP in predicting in-hospital and post-discharge HF in patients with ant-STEMI. (A) The AUC of GLS was 0.753 (95% CI, 0.682–0.816; p<0.001) which was comparable (p=0.532) with LVEF (AUC, 0.735; 95% CI, 0.662–0.800; p<0.001) and significantly higher (p=0.012) than that of NT-proBNP (AUC, 0.600; 95% CI, 0.516-0.679; p=0.072) to predict in-hospital HF. (B) In prediction of post-discharge HF, LSant (AUC, 0.715; 95% CI, 0.630–0.790; p=0.010) and NT-proBNP (AUC, 0.720; 95% CI, 0.628-0.801; p=0.005) were comparable (p=0.585), but LVEF showed poor discriminatory power (AUC, 0.643; 95% CI, 0.555–0.725; p=0.055). ant-STEMI = anterior wall ST-segment elevation myocardial infarction; AUC = area under the curve; CI = confidence interval; GLS = global longitudinal strain; HF = heart failure; LSant = mean longitudinal strain of left anterior descending artery territory; LVEF = left ventricular ejection fraction; NT-proBNP = N-terminal pro-brain natriuretic peptide; ROC = receiver operating characteristic.


Cited by  2 articles

Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field
Jae-Hyeong Park
Korean Circ J. 2019;49(10):908-931.    doi: 10.4070/kcj.2019.0200.

Myocardial Longitudinal Strain in Prediction of Heart Failure after Acute Myocardial Infarction
Hyemoon Chung
Korean Circ J. 2019;49(10):973-974.    doi: 10.4070/kcj.2019.0132.


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