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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler
Mohamed Loutfi1, Sanaa Ashour1, Eman El-Sharkawy1
1Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Global longitudinal strain (GLS) effectively predicts left ventricular infarct size in patients with non-ST segment elevation myocardial infarction (NSTEMI). This echocardiography technique aids in identifying high-risk NSTEMI patients for better clinical decision-making.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Left ventricular (LV) function assessment is crucial for acute coronary syndrome (ACS) management.
- Non-ST segment elevation myocardial infarction (NSTEMI) patients often have significant myocardial infarction but lack clear instability signs.
- Accurate infarct size assessment is vital for risk stratification in NSTEMI.
Purpose of the Study:
- To evaluate strain Doppler echocardiography, specifically global longitudinal strain (GLS), for assessing LV infarct size.
- To compare GLS with standard two-dimensional echocardiography and cardiac magnetic resonance (CMR).
Main Methods:
- Thirty NSTEMI patients underwent echocardiography (including GLS) and CMR for infarct size assessment.
- Echocardiography measured LV ejection fraction, wall motion score index (WMSI), and GLS.
- CMR assessed infarct size as a percentage of total myocardial volume.
Main Results:
- GLS showed significant correlations with LV ejection fraction and WMSI from standard echo, and CMR-derived EF.
- GLS was the strongest independent predictor of infarct size in multivariate analysis.
- GLS cutoff of -11.29% identified substantial infarction (≥12% myocardial volume) with 80% accuracy.
Conclusions:
- Global longitudinal strain (GLS) is a valuable predictor of infarct size in NSTEMI.
- GLS can be used alongside risk scores to identify high-risk NSTEMI patients.
Unlabelled:
Assessment of left ventricular (LV) function is important for decision-making and risk stratification in patients with acute coronary syndrome. Many patients with non-ST segment elevation myocardial infarction (NSTEMI) have substantial infarction, but these patients often do not reveal clinical signs of instability, and they rarely fulfill criteria for acute revascularization therapy.
Aim:
This study evaluated the potential of strain Doppler echocardiography analysis for the assessment of LV infarct size when compared with standard two-dimensional echo and cardiac magnetic resonance (CMR) data.
Methods:
Thirty patients with NSTEMI were examined using echocardiography after hospitalization for 1.8 ± 1.1 days for the assessment of left ventricular ejection fraction, wall motion score index (WMSI), and LV global longitudinal strain (GLS). Infarct size was assessed using delayed enhancement CMR 6.97 ± 3.2 days after admission as a percentage of total myocardial volume.
Results:
GLS was performed in 30 patients, and 82.9% of the LV segments were accepted for GLS analysis. Comparisons between patients with a complete set of GLS and standard echo, GLS and CMR were performed. The linear relationship demonstrated moderately strong and significant associations between GLS and ejection fraction (EF) as determined using standard echo (r = 0.452, P = 0.012), WMSI (r = 0.462, P = 0.010), and the gold standard CMR-determined EF (r = 0.57, P < 0.001). Receiver operating characteristic curves were used to analyze the ability of GLS to evaluate infarct size. GLS was the best predictor of infarct size in a multivariate linear regression analysis (β = 1.51, P = 0.027). WMSI >1.125 and a GLS cutoff value of -11.29% identified patients with substantial infarction (≥12% of total myocardial volume measured using CMR) with accuracies of 76.7% and 80%, respectively. However, GLS remained the only independent predictor in a multivariate logistic regression analysis to identify an infarct size ≥12%.
Conclusion:
GLS is a good predictor of infarct size in NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk NSTEMI patients.
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