Transmural difference in myocardial damage assessed by layer-specific strain analysis in patients with ST elevation
Sua Kim1, Dong-Hyuk Cho2, Mi-Na Kim2
1Department of Critical Care Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Insights
Strain gradient analysis using echocardiography can predict myocardial viability after ST-segment elevation myocardial infarction (STEMI). Reduced strain gradient indicates irreversible damage, aiding in assessing heart muscle recovery post-STEMI.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- ST-segment elevation myocardial infarction (STEMI) causes significant myocardial damage.
- Assessing myocardial viability is crucial for guiding treatment and predicting outcomes after STEMI.
- Layer-specific strain analysis offers a detailed view of myocardial function.
Purpose of the Study:
- To investigate transmural differences in myocardial damage using layer-specific strain analysis.
- To determine if strain gradient (SG) can predict myocardial viability in STEMI patients.
- To evaluate the relationship between wall motion abnormalities and strain parameters.
Main Methods:
- Layer-specific strain analysis with speckle-tracking echocardiography was performed.
- Patients with acute STEMI underwent primary percutaneous coronary intervention and echocardiography at baseline and 2 months.
- Segmental strains of the left ventricular (LV) endocardium, myocardium, epicardium, and SG were evaluated.
Main Results:
- Layer-specific strains deteriorated with worsening wall motion.
- SG increased in hypokinetic segments with progressing wall motion impairment.
- SG differed between viable and non-viable akinetic/dyskinetic segments, being maintained in viable ones.
Conclusions:
- Significantly reduced SG indicates irreversible transmural damage in acute STEMI.
- Strain gradient is a suitable parameter for predicting myocardial viability after STEMI.
- Layer-specific strain analysis provides valuable insights into myocardial recovery post-infarction.
Abstract:
We performed layer-specific strain analysis with speckle-tracking echocardiography to investigate the transmural difference of myocardial damage as the predicting factor for the viability of damaged myocardium in patients with ST segment elevation myocardial infarction (STEMI). We analysed patients with acute STEMI who had undergone primary percutaneous coronary intervention and echocardiography within 24 h from the intervention and 2 months after the event. Segmental strains of the left ventricular (LV) endocardium, myocardium, epicardium, and strain gradient (SG) between the endocardium and epicardium were evaluated. In 34 patients, 112 akinetic/dyskinetic and 94 hypokinetic segments were observed among 612 segments of the LV at baseline, and 65 akinetic/dyskinetic segments had viability. In our study, layer-specific strains were gradually deteriorated by their wall motion. SG was augmented in the hypokinetic segments where inhomogeneous wall motion impairment was progressed. SG in the akinetic/dyskinetic segments was different between the viable and non-viable myocardium and was maintained in viable segments. We therefore believe that significantly reduced SG is indicative of irreversible transmural damage in the acute stage of STEMI and can be suitably used as a parameter for predicting myocardial viability.
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