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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Mechanical dispersion combined with global longitudinal strain estimated by three dimensional speckle tracking in
Noriaki Iwahashi1, Jin Kirigaya1, Masaomi Gohbara1
1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Insights
Three-dimensional left ventricular mechanical dispersion, assessed by 3D speckle-tracking echocardiography, effectively predicts major adverse cardiac events after ST-elevation myocardial infarction (STEMI). This 3D measure offers valuable prognostic information beyond global longitudinal strain.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- The prognostic significance of left ventricular (LV) mechanical dispersion following ST-elevation acute myocardial infarction (STEMI) remains incompletely understood.
- Assessing LV mechanical dispersion may offer insights into post-STEMI cardiac function and patient outcomes.
Purpose of the Study:
- To investigate the role of LV mechanical dispersion, evaluated using 2D and 3D speckle-tracking echocardiography (STE), in predicting long-term prognosis after STEMI.
- To determine if 3D-derived LV mechanical dispersion is a significant predictor of major adverse cardiac events (MACE).
Main Methods:
- 208 patients with first-time STEMI underwent primary percutaneous coronary intervention (PCI) and subsequent 2D and 3D STE within 48 hours.
- LV mechanical dispersion was quantified as the standard deviation of time to regional peak longitudinal strain (LS-SD) using both 2D and 3D STE.
- Patients were followed for a median of 118 months for MACE (cardiac death, heart failure), with infarct size assessed by Tc99m-sestamibi.
Main Results:
- A 3D-LS-SD cutoff of >56.7 ms was a significant independent predictor of MACE (HR=1.991, p=0.03).
- In contrast, 2D-LS-SD >58.1 ms did not independently predict MACE (HR=1.577, p=0.1).
- The combination of 3D global longitudinal strain (3D-GLS) and 3D-LS-SD demonstrated accurate predictability for MACE (log rank, χ²=94.1, p<0.0001).
Conclusions:
- LV mechanical dispersion assessed by 3D STE, in addition to 3D-GLS, immediately after PCI can predict long-term prognosis in STEMI patients.
- 3D STE-derived LV mechanical dispersion offers superior prognostic value compared to 2D STE in this patient cohort.
Background:
The role of left ventricular (LV) mechanical dispersion estimated after an ST elevation acute myocardial infarction (STEMI) remains unclear.
Methods:
The study participants were 208 consecutive patients (152 men, age = 72 years) presenting with STEMI for the first time who underwent primary percutaneous coronary intervention (PCI) within 12 h of STEMI onset. Within 48 h of PCI (mean = 24 h), 2D and 3D speckle-tracking echocardiography were performed. The global longitudinal strain (GLS) was calculated using 3D (3D-GLS) and 2D (2D-GLS) speckle tracking. Mechanical dispersion was defined using the standard deviation (SD) of the time to regional peak longitudinal strain (LS) for all 16 segments for both 2D-STE and 3D-STE (2D-LS-SD, 3D-LS-SD). Infarct size was estimated by Tc99m-sestamibi as the total area of < 50% of the uptake area at 2 weeks. The patients were followed up for a longer period of time (median118months) and checked for major adverse cardiac events (MACE: cardiac death, heart failure).
Results:
During follow-up, 55 patients experienced MACE. The cut-off values were determined using receiver operating characteristic curves. The multivariate analysis revealed that a 3D-LS-SD > 56.7 ms was a significant predictor of MACEs (hazard ratio = 1.991, 95% confidence interval 1.033-3.613, p = 0.03), but 2D-LS-SD > 58.1 ms was not an independent predictor of MACEs (hazard ratio = 1.577, 95% confidence interval 0.815-3.042, p = 0.1). Furthermore, the combination of 3D-GLS and 3D-LS-SD had accurate predictability for MACE, as shown by the Kaplan-Meier curves (log rank, χ2 = 94.1, p < 0.0001).
Conclusions:
LV mechanical dispersion besides 3D-GLS assessed by 3D-STE immediately after PCI can predict long-term prognosis.
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