Evaluation of myocardial viability in patients with acute myocardial infarction

Abstract

Background:The value of layer-specific two-dimensional speckle tracking echocardiography (LS2D-STE) for evaluating viable myocardium (VM) in patients with acute myocardial infarction (AMI) was unclear, this study provides new insights into it and to make a comparison with dualisotope simultaneous acquisition single photon emission computed tomography ( DISA-SPECT).Methods:Forty hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) underwent LS2D-STE and DISA-SPECT before percutaneous coronary intervention (PCI). The longitudinal, circumferential, and radial peak systolic strains and the peak systolic strain rates of 3 myocardiallayers (endocardium, mid-myocardium, and epicardium), as well as the total wall thickness, were determined by LS2D-STE. Routine echocardiography was followedup at 1, 3, 6 months after PCI, with the improvement of the wall motion as the goldenstandard for evaluating VM.Results:The sensitivity, specificity and accuracy of DISA-SPECT for evaluating VM were 82.1%, 74.3%, and 79.3%, respectively. Among the layer-specific parameters, only endocardial (endo-) longitudinal strain (LS) and endo- longitudinal strain rate (LSr) were used as independent parameters for evaluating VM (P < .05), and the sensitivity, specificity and accuracy of endo-LS and endo-LSr in evaluation of VM were 77.1%, 65.4%, and 72.9% vs 72.9%, 65.4%, and 69.7%. Endo-LS and endo-LSr were superior to total wall thickness LS and LSr (AUC endo-LS 0.767 vs total-LS 0.669; endo-LSr 0.743 vs total-LSr 0.682). The parallel test and the serial test of combination of endo-LS and endo-LSr showed similar sensitivity, specificity and accuracy to DISA-SPECT (P > .05).Conclusion:The endo-LS and endo-LSr analysis of LS2D-STE can evaluate the VM well, and its sensitivity, specificity and accuracy in detection of VM are similar to those of DISA-SPECT, resulting in LS2D-STE being a good option for the assessment of VM.

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

“…193,194 In addition, in small cohorts of patients, STE seems a useful tool to detect and assess the amount of fibrosis and myocardial viability during low-dose dobutamine stress. 195,196 Moreover, in a cohort of patients with normal LVEF at increased atherosclerotic risk and/or with stable chest pain, a progressive impairment of GLS was directly related to the increasing severity of CAD as assessed by multislice computed tomography. A GLS of -17.4% provided high sensitivity and specificity (83% and 77%, respectively) in identifying patients with obstructive coronary disease.…”

“…In fact, in diagnosing CCS non‐invasively, resting GLS performs similarly to stress‐echocardiography variables (wall motion or coronary reserve) for CAD detection, with the advantage of a semi‐automated, cost‐effective and reproducible measurement 193,194 . In addition, in small cohorts of patients, STE seems a useful tool to detect and assess the amount of fibrosis and myocardial viability during low‐dose dobutamine stress 195,196 …”

The value of STE-LDDSE to detect viable myocardium

“…Follow-up echocardiography was performed at 1, 3, and 6 months after PCI. The improvement of RWMA systolic function after PCI is recognized as the "gold standard" for judging viable myocardium.Based on the "gold standard", 540 segments were followed up, which 365 segments classi ed as viable myocardium and 175 segments classi ed as non-viable myocardium (13)(14)(15)(16)). Among the 183 segments followed up in the DM group, which 117 segments were classi ed as viable myocardium and 66 segments were classi ed as non-viable myocardium.…”

Preliminary discussions about myocardial injury and rehabilitation

“…Myocardial infarction is a serious threat to human health. Drug therapy and antithrombotic therapy cannot restore cardiac blood flow and repair damaged cardiac tissue (21).…”