Prognostic value of longitudinal strain after primary reperfusion therapy in patients with anterior-wall acute myocardial infarction.

Abstract

OBJECTIVES: We sought to test whether longitudinal strain (LS) can be a useful predictor of left ventricular (LV) remodeling after reperfusion therapy in acute myocardial infarction.

BACKGROUND: Predicting LV remodeling based on quantification of regional contractility remains an elusive goal of echocardiography.

METHODS: In 50 patients with anterior-wall acute myocardial infarction, the peak systolic velocity and LS were measured by Doppler tissue imaging (LS(DTI)) and speckle tracking imaging (LS(2D)) at 7 LV segments of left anterior descending coronary artery territory after primary reperfusion therapy. LV remodeling was defined as an increase in LV end-diastolic volume of greater than or equal to 15% at follow-up echocardiography.

RESULTS: A total of 22 patients showed LV remodeling, who had significantly lower baseline ejection fraction, LS(DTI), and LS(2D), and higher wall-motion score index and peak creatine kinase-MB with shorter deceleration time of early diastolic mitral inflow than those without LV remodeling. LS(2D) (odds ratio [OR] = 1.307, 95% confidence interval [CI] = 1.082-1.579, P = .005) and LS(DTI) (OR = 1.430, 95% CI = 1.152-1.776, P = .001) were independent predictors of LV remodeling. During clinical follow-up of 18.3 +/- 9.0 months, death or congestive heart failure developed in 11 patients (22%); LS(2D) (OR = 1.455, 95% CI = 1.142-1.852, P = .002) and LS(DTI) (OR = 1.436, 95% CI = 1.093-1.888, P = .009) were independent predictors.

CONCLUSIONS: LS immediately after primary reperfusion therapy is an excellent predictor of LV remodeling and adverse events in patients with anterior-wall acute myocardial infarction.