Speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior ST elevation myocardial infarction in patients managed by primary percutaneous coronary intervention

Abstract

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. LV remodeling is an important factor in the pathophysiology of advancing heart failure (HF).Aim of the workTo evaluate the value of speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior STEMI in patients managed by primary PCI.MethodologyEighty-five patients with first acute anterior STEMI underwent primary PCI. Patients were followed up for 6 months. Echocardiographywas done within 48 h [1] Standard transthoracic 2D echocardiographic examination: LV internal dimensions and volumes, Left Ventricular EF, and Wall Motion Score Index: [2] LV peak systolic global longitudinal strain and Torsion dynamics were assessed. Echocardiography was repeated at 6 months LV volumes and EF were calculated. LV remodeling was defined as an increase in LV EDV ≥ 20% 6 months after infarction as compared to baseline data. Patients were then classified into Group I: did not develop LV remodeling. Group II: developed LV remodeling. Both groups were studied to determine predictors of LV remodeling.ResultsAt baseline echocardiographic evaluation there was no statistically significant difference between both groups regarding both LVEDD and LVEDV, while there was statistically significant increase in both LV ESD and LV ESV, with statistically significant lower Ejection Fraction, in LV remodeling group. There was also statistically significant higher LV peak systolic GLS values in LV remodeling group, the best cut-off value was >−12.5 (Sensitivity 87%, Specificity 85%) and LV torsion was also statistically significantly lower in the LV remodeling group, with the best cut-off value for LV torsion was <9.5°, [Sensitivity 91%, Specificity 85%].Independent predictors of LV remodeling after AMI: baseline WMSI > 1.8, baseline LV EF < 40, GLS > −12.5%, LV torsion < 9.5°, CK-MB > 500 U/L, baseline Thrombus grade > 4 and total ischemic time.ConclusionAverage peak systolic GLS and LV torsion at echocardiography done early after myocardial infarction are independent predictors of LV remodeling after anterior STEMI and can be used to predict occurrence of LV remodeling after 6 months.

Role of Speckle Tracking in the Evaluation of Left Ventricular Remodeling After Streptokinase Infusion in Patients with Acute Anterior Myocardial Infarction

“…По данным I. Bastawy с соавт. [17] средний пиковый систолический ГПД>-12.5% является независимым предиктором ремоделирования ЛЖ.…”

The Value of Three-Dimensional Speckle-Tracking Echocardiography in the Prediction of Cardiovascular Events in Patients with Hypertension Complicated by Acute Myocardial Infarction: A Long-Term Follow-Up Study

“…In studies comparable to ours, a GLS value of −12% to −14% was independently associated with mortality, heart failure, and stroke. 19,25,26 These results may provide valuable information for the clinical treatment of patients with hypertension and AMI.…”

Understanding the role of echocardiography in remodeling after acute myocardial infarction and development of heart failure with preserved ejection fraction

“…Myocardial deformation is linked to the longitudinally oriented fibers, located in the sub-endocardium, which are the most susceptible to ischemic changes. It was demonstrated in many studies that GLS detects longitudinal abnormalities in the absence of reduction in LVEF [22][23][24][25]. This is due to the fact that fibers located in the mid-wall, which are circumferentially oriented, may compensate in the case of reduction of the longitudinal mechanics in order to maintain LVEF normal.…”

“…Lacalzada et al demonstrated that GLS (>-12.46%) was a predictor of adverse remodeling and cardiac events in patients with AMI [31]. Moreover, Bastawy et al demonstrated that GLS (>-12.5%) and LV torsion (< 9.5°) early after anterior STEMI treated with primary PCI are independent predictors of six months LV remodeling [24].…”