Left ventricular global longitudinal strain predicts left ventricular remodeling

Abstract

Background: One of the most prognostically significant consequences of acute myocardial infarction (MI) is the development of adverse left ventricular (LV) remodeling and early identification of it is of clinical importance. Objectives: The purpose of our study was to evaluate feasibility of speckle-tracking imaging (in particular global longitudinal strain (Ls)) in predicting LV remodeling after MI. Methods: A total of 61 patients (mean age 57+9.4) with acute MI who underwent primary percutaneous coronary intervention were included. Within 2-4 days of the onset of acute MI, 2-dimensional echocardiography was performed. The apical two and four chamber view of the heart was analyzed offline using Echo Pac software for the assessment of strain with the speckle tracking imaging method. At 3-month follow-up LV volumes, LV ejection fraction (LVEF) were reassessed. LV remodeling was defined as a 15% increase from baseline in LV end diastolic volume. Results:Patients with LV remodeling at 3-month follow-up (42%)hadcomparable baseline clinical and echocardiographic characteristics with patients without LV remodeling (58%), except for predominating anterior wall MI (p , 0.001), lower LVEF (p-0.03) and reduced global systolic longitudinal strain (Ls) (p , 0.001). Logistic regression analysis showed that anterior wall MI (O.R. 4.1; 95% CI 1.04–16.17), LVEF , 50% (O.R. 3.7; 95% CI 0.95-14.81) and global systolic Ls (O.R.3.8; 95%CI 1.02-14.29) were independent determinants of LV remodeling after MI. A receiver-operating characteristic curve analysis showed that a cutoff value of –15.1%for systolic Ls yielded a 73%sensitivity and a 77%specificity to predict LV remodeling in 3 months. Conclusions: Our study demonstrates that longitudinal strain imaging is a promising potential echocardiographic parameter to predict LV remodeling after acute MI.