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Predicting left ventricular function recovery after reperfusion in ST elevation myocardial infarction: can we balance cost and accuracy?

TL;DR: Keywords: left ventricle; myocardial infarction; strain imaging; Myocardial strain; echocardiography; systolic function
Abstract: Keywords: left ventricle; myocardial infarction; strain imaging; myocardial strain; echocardiography; systolic function
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Journal ArticleDOI
TL;DR: 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 but can be improved by a layer-specific analysis of endocardial deformation.
Abstract: 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 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.

67 citations


"Predicting left ventricular functio..." refers background in this paper

  • ...Cost of a cardiac MRI is 10 times that of an echocardiogram, but the accuracy of predicting LV function recovery is similar.(8) Echocardiographic strain analysis is thus a cheap and accurate method that will be widely accepted for use for this purpose....

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Journal ArticleDOI
TL;DR: Improvement of strain in peri-infarct myocardium closely follows regression of myocardial edema, and volume of edema and intensity of signal on T2-weighted images relate to functional recovery after reperfused AMI.
Abstract: Early after acute myocardial infarction, the peri-infarct zone delineated by T2-weighted MR imaging demonstrates significantly impaired strain compared with remote myocardium, and recovery of regional function in the peri-infarct zone follows the normalization of T2-weighted signal intensity.

42 citations

Journal ArticleDOI
TL;DR: In HORIZONS-AMI, MBG and STR after primary PCI were concordant in only 70% of patients and provided complementary prognostic information, whereas myocardial blush grade predicted long-term survival, whereas STR predicted freedom from repeated revascularization.

29 citations

Journal ArticleDOI
TL;DR: Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI.
Abstract: We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE). STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function. Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001). Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI. • Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI • Baseline CS predicts contractile function recovery better than baseline CSR following STEMI • Baseline CS provides incremental value to LGE and MVO following STEMI

20 citations

Journal ArticleDOI
TL;DR: Improvement of SWT occurred exclusively within the first 4 months after acute myocardial infarction and remained unchanged thereafter and is related to rapid revascularization of the infarct-related artery and the absence of microvascular obstruction.
Abstract: We sought to analyze the trend of functional recovery after successful reperfused ST-elevation myocardial infarction (STEMI) in an optimally treated patient group over a 14 month follow-up in relation to ischemia-time and the presence of microvascular obstruction (MVO). First-pass perfusion-, cine- and late enhancement (LE)- cardiac MR were performed in 40 patients (33 male and 7 female, 54.8 ± 12.3 years) within 6 days as well as 4 and 14 months after successful primary percutaneous coronary intervention for STEMI. Significant recovery of segmental wall thickening (SWT %) occurred exclusively in infarcted segments reperfused within 4 h after symptom onset (group 1 with pain-to-balloon time <2 h: 59 ± 4 to 70 ± 4%; P < 0.02) (group 2 with pain-to-balloon-time 2–4 h: 51 ± 4 to 59 ± 3%, P < 0.05) during the first 4 months, whereas changes thereafter were not significant (P = NS). Infarcted segments with MVO showed lowest regional myocardial function at any time of assessment (all P < 0.001) and a lack of significant recovery during the study period. Significant recovery of regional myocardial function is related to rapid revascularization of the infarct-related artery and the absence of MVO. Improvement of SWT occurred exclusively within the first 4 months after acute myocardial infarction and remained unchanged thereafter.

16 citations