Clinical Investigation
Coronary Artery Disease
Myocardial Deformation Imaging by Two-Dimensional Speckle-Tracking Echocardiography for Prediction of Global and Segmental Functional Changes after Acute Myocardial Infarction: A Comparison with Late Gadolinium Enhancement Cardiac Magnetic Resonance

https://doi.org/10.1016/j.echo.2013.11.014Get rights and content

Background

Myocardial deformation analysis by speckle-tracking echocardiography (STE) has been shown to accurately predict viability in patients with chronic ischemic left ventricular (LV) dysfunction. The aim of this study was to evaluate two-dimensional STE for the prediction of global and segmental LV functional changes after acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR).

Methods

In 93 patients (mean age, 60 ± 11 years) with first AMIs (55 with ST-segment elevation myocardial infarctions and 38 with non–ST-segment elevation myocardial infarctions) treated with acute percutaneous coronary intervention, global peak longitudinal strain was determined to describe global function by STE, and peak systolic circumferential and longitudinal strain was determined for segmental function analysis. LGE CMR was performed to define the amounts of global and segmental myocardial scar. STE and LGE CMR were performed within 48 hours of AMI. At 6-month follow-up, transthoracic echocardiography was repeated to determine global und segmental LV recovery and adverse LV remodeling (increase in end-systolic volume > 15%).

Results

Accuracy to predict global functional improvement as well as LV remodeling at 6-month follow-up after AMI was similar for STE and LGE CMR (areas under the curve, 0.715 vs 0.729 [P = .8830] and 0.806 vs 0.824 [P = .7141], respectively). Peak systolic circumferential strain < −14.2% had sensitivity of 71.6% and specificity of 58.1% to predict segmental functional improvement. Compared with LGE CMR, the predictive accuracy of transmural STE for segmental functional improvement at 6-month follow-up was lower (area under the curve, 0.788 vs 0.668; P = .0001). Predictive accuracy for segmental functional improvement could be improved by analysis of endocardial circumferential strain (area under the curve, 0.700 vs 0.668 for transmural speckle-tracking echocardiographic analysis; P = .0023).

Conclusions

Two-dimensional STE allows the prediction of global functional recovery as well as LV remodeling after AMI with accuracy comparable with that of LGE CMR. Accuracy to predict segmental functional recovery using transmural deformation analysis by two-dimensional STE is inferior compared with LGE CMR but can be improved by a layer-specific analysis of endocardial deformation.

Section snippets

Study Population

We screened 300 consecutive patients for possible inclusion in the study. Patients had to be in sinus rhythm and to have undergone acute percutaneous intervention for first AMI. Revascularization had to be achieved in all perfusion beds. Contraindications to CMR, such as device therapy or severe renal dysfunction, as well as insufficient echocardiographic windows resulted in exclusion from the study. Further exclusion criteria were significant valvular heart disease and previous myocardial

Results

LGE analysis could be performed in all LV segments. LV ejection fractions immediately after AMI were reduced to <55% in 44 patients. In 18 of these 44 patients (41%), LV ejection fractions increased absolutely by ≥5% at 6-month follow-up, while in 26 patients (59%), LV ejection fractions did not increase. Analysis of global LV remodeling demonstrated increases of ESV of >15% in 11 patients (12%) from baseline to 6-month follow-up, while in 82 patients (88%), ESV did not increase. In 1,287

Discussion

The major findings of this study are that (1) STE allows the prediction of global functional recovery as well as LV remodeling 6 months after AMI with similar accuracy compared with LGE CMR; (2) STE enables the prediction of segmental functional improvement after AMI, but predictive accuracy is inferior to that of LGE CMR; and (3) endocardial layer–specific analysis of circumferential myocardial deformation improves accuracy for the prediction of segmental functional improvement.

After AMI,

Conclusions

In patients with AMIs, accuracy for the prediction of global functional improvement as well as LV remodeling by 2D STE is comparable with that of LGE CMR. The prediction of segmental functional improvement is noninferior using myocardial deformation analysis by 2D STE compared with LGE CMR in patients with STEMIs, while accuracy for the prediction of segmental functional improvement in patients with NSTEMIs is lower. Endocardial layer circumferential strain analysis improves the accuracy of STE

References (28)

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    Although it was not the purpose of the study, echocardiography could underestimate the true incidence of LV thrombus compared with magnetic resonance imaging, but all the patients selected had a good delineation of the apex, which permitted a clear quantification of WMA by experienced sonographers, and this limitation was applied to all patients. Finally, using a final wall motion score of 1 at the segmental level seems a simple and reproducible method to detect transmural recovery but underestimates the true extent of viability, which is best evaluated by magnetic resonance imaging.27 In patients with anterior STEMI, noninvasive MW assessed within 24-48 hours of PCI is easily performed at bedside using strain data and noninvasive blood pressure.

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This study was supported by a research grant from the German-Israeli Foundation for Scientific Research & Development (I-873-77.10/2005).

Dr Friedman is a part-time employee of GE Ultrasound. Dr Hoffmann has received research funding from GE Ultrasound.

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