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Global longitudinal strain value for predicting left ventricular remodeling after primary percutaneous reperfusion therapy in acute myocardial infarction

Introduction

After an acute myocardial infarction with ST-segment elevation (STEMI) treated with percutaneous coronary intervention (PCI), the left ventricle (LV) can undergo negative remodeling (R-). We aimed to investigate whether global longitudinal strain (SGL) of the left ventricle (LV) predicts remodeling.

Methods

Transthoracic echocardiography with speckle tracking imaging (TTE-STI) was performed 2 to 3 days after primary PCI and 6 months later in patients with diagnosis of STEMI. LV R- criteria were: LVEF increase ≤5% and end-diastolic volume increase ≥15%. Logistic regression and ROC curve analysis was used for the statistical analysis.

Results

Eighty-three patients (56 ± 11 years) with STEMI at any LV localization and subjected to primary PCI were studied during 2012: LV R- patients (n = 35, 42%) and no LV R- patients (n = 48, 58%). Diabetes mellitus (41% vs. 19%; P < 0.001) and TnI levels (1.2 ± 2.1 μg/l vs. 0.4 ±0.3 μg/l; P = 0.005) showed higher incidence in LV R- patients. SGL was -12.5 ± 5.6% in no LV R- patients and -6.5 ± 3.4 in LV R- patients. In the regression analysis just LV SGL and SL in left anterior descending territory remained significant, OR: 1.85 (1.24 to 2.76) (P < 0.001) and OR: 1.63 (1.15 to 2.31) (P < 0.001), respectively. The analysis of ROC curves revealed that at the cutoff level of -12.46%, SGL identifies LV R- with a sensibility of 81% and a specificity of 86% (AUC = 0.88: 95% CI: 0.79 to 0.96; P < 0.001) (Figure 1).

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Figure 1

Conclusion

SGL assessment in the first days after primary PCI is useful in the prediction of LV R- independently of the myocardial infarction localization.

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Jiménez, J., Iribarren, J., Lacalzada, J. et al. Global longitudinal strain value for predicting left ventricular remodeling after primary percutaneous reperfusion therapy in acute myocardial infarction. Crit Care 19, P162 (2015). https://doi.org/10.1186/cc14242

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Keywords

  • Left Ventricle
  • Percutaneous Coronary Intervention
  • Acute Myocardial Infarction
  • Transthoracic Echocardiography
  • Ventricular Remodel