Prediction of Left Ventricular Remodeling after a Myocardial Infarction: Role of Myocardial Deformation: A Systematic Review and Meta-Analysis

Abstract

AimsLeft ventricular (LV) adverse or reverse remodeling after ST-segment elevation myocardial infarction (MI) is the best outcome to assess the benefit of revascularization. Speckle tracking echocardiography (STE) may accurately identify early deformation impairment, while also being predictive of LV remodeling during follow-up. This systematic analysis aimed to provide a comprehensive review of current findings on STE as a predictor of LV remodeling after MI.MethodsPubMed databases were searched through December 2014 to identify studies in adults targeting the association between LV remodeling and STE. Meta-regression was performed for longitudinal analysis.ResultsA total of 23 prospective studies (3066 patients) were found eligible. Eleven studies reported an association between STE and adverse remodeling and twelve studies with reverse remodeling. Using peak systolic longitudinal strain, the most accurate cut-off to predict adverse remodeling and reverse remodeling ranged from -12.8% to -10.2% and from -13.7% to -9.5%, respectively. In smaller studies, assessment of circumferential strain and torsion showed additive value in predicting remodeling. Meta-regression analysis revealed that longitudinal STE was associated with adverse remodeling (pooled univariable OR = 1.27, 1.17–1.38, p<0.001; pooled multivariable OR = 1.38, 1.13–1.70, p = 0.002) while pooled ORs of longitudinal STE only tended to predict reverse remodeling (pooled OR = 0.75, 0.54–1.06, p = 0.09).ConclusionsThis systematic review suggests that STE is associated with changes in LV volume or function regardless of underlying mechanisms and deformation direction. Meta-regression demonstrates a strong association between peak longitudinal systolic strain and adverse remodeling. Added STE predictive value over other clinical, biological and imaging variables remains to be proven.

The impact of high‐intensity interval training on ventricular remodeling in patients with a recent acute myocardial infarction—A randomized training intervention pilot study

“…On the other hand, GLS rate showed a slight improvement only in the usual care group in our study. Similarly, the most important parameter in the prediction of ventricular remodeling, GLS, tended to improve over time, but more pronounced in the usual care group . A recent explorative non‐randomized study found no beneficial effects on left ventricular dimension and function in post‐AMI patients (including GLS and LV twist) .…”

“…It is more sensitive for the detection of subclinical LV changes as compared to standard LV ejection fraction (LVEF) measurement . The best evaluated parameter, global longitudinal strain (GLS) is superior to LVEF in the prediction of prognosis and cardiac remodeling after AMI . Among others, cardiac β‐adrenergic receptor (β‐AR) signal dysregulation represents a hallmark abnormality potentially leading to LV remodeling post‐AMI and progression to heart failure.…”

“…3 The best evaluated parameter, global longitudinal strain (GLS) is superior to LVEF in the prediction of prognosis and cardiac remodeling after AMI. [4][5][6] Among others, cardiac β-adrenergic receptor (β-AR) signal dysregulation represents a hallmark abnormality potentially leading to LV remodeling post-AMI and progression to heart failure. β-AR kinase (GRK2) is the most abundant G protein-coupled receptor kinase expressed in the heart.…”

Recovery of regional systolic and diastolic myocardial function after acute myocardial infarction evaluated by two‐dimensional speckle tracking echocardiography

“…Previous reports, both experimental and clinical, have demonstrated usefulness of systolic deformation parameters for the assessment of viability and predicting recovery of regional function after myocardial infarction (Zhang et al ., ; Migrino et al ., ; Vartdal et al ., ; Lipiec et al ., ; Szymczyk et al ., ). Peak SLS measurements obtained by speckle tracking echocardiography have also been shown to be predictive of left ventricular remodelling after myocardial infarction (Huttin et al ., ). In our study, we confirmed most of these observations.…”

The Potential of Clinical Phenotyping of Heart Failure With Imaging Biomarkers for Guiding Therapies

“…Novel functional strategies using assessment of myocardial deformation with speckle tracking echocardiography can be used readily at the bedside. Several studies have suggested that assessment of peak systolic longitudinal strain after revascularization in patients with acute myocardial infarction can be used for predicting global improvement in LVEF (32). …”