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High-frequency High-resolution Echocardiography: First Evidence on Non-invasive Repeated Measure of Myocardial Strain, Contractility, and Mitral Regurgitation in the Ischemia-reperfused Murine Heart
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Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment

Loïc Bière1, Erwan Donal2, Gwenola Terrien1

  • 1L'UNAM Université, Angers, France ; Université Angers, UPRES EA3860, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU Angers, Service de Cardiologie, Angers, France.

Plos One
|February 4, 2014
PubMed

Insights

Early speckle tracking strain imaging after ST-segment elevation myocardial infarction (STEMI) effectively predicts infarct size and functional recovery. Global longitudinal strain (GLS) is a key predictor of microvascular obstruction and final infarct size, aiding in patient prognosis.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires early assessment of infarct size and functional recovery for prognosis.
  • Speckle tracking imaging (STI) is a non-invasive echocardiographic technique that measures myocardial deformation.
  • Cardiac magnetic resonance (CMR) imaging is the gold standard for quantifying infarct size and microvascular obstruction (MVO).

Purpose of the Study:

  • To evaluate the early predictive value of STI parameters for infarct size and functional recovery at 3-month follow-up after STEMI.
  • To assess the correlation between STI-derived global longitudinal strain (GLS) and infarct size, MVO, and ejection fraction.
  • To determine if GLS can predict persistent akinetic territories post-STEMI.

Main Methods:

  • Prospective enrollment of 44 STEMI patients treated within 12 hours of symptom onset.
  • Echocardiography for speckle tracking strain analysis (GLS, CGS, RGS) performed early post-reperfusion (3.9 ± 1.2 days).
  • Late gadolinium-enhanced CMR performed for assessing cardiac function, infarct size, and MVO at early (5.6 ± 2.5 days) and late (99.4 ± 4.6 days) follow-up.

Main Results:

  • Infarct size significantly correlated with GLS (R=0.601), RGS (R=-0.405), CGS (R=0.526), ejection fraction (R=-0.699), WMSI (R=0.539), and left atrial volume (R=0.510).
  • Baseline ejection fraction and GLS were independent predictors of 3-month infarct size.
  • GLS was the only independent predictor of MVO mass (p=0.015) and correlated significantly with MVO (R=0.376).
  • Longitudinal strain >-6.0% predicted persistent akinesia with 96% specificity and 61% sensitivity.

Conclusions:

  • Early speckle tracking strain imaging after STEMI is a valuable and easy-to-use tool for predicting persistent akinetic territories at 3 months.
  • GLS derived from STI correlates significantly with MVO and final infarct size, providing prognostic information typically obtained by CMR.
  • STI offers a promising, accessible method for risk stratification and management of STEMI patients.
Abstract

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