4939Clinical significance of global strain estimated by 3D speckle tracking acutely after onset of ST-elevation myocardial infarction on prediction of long term prognosis

Abstract

Abstract Background Three-dimensional (3D) speckle tracking echocardiography (STE) is a novel method for assessing cardiac function because of free form out-of-plane motion effects. Aim To explore the role of 3D-STE for prediction of the long term prognosis in patients with a first-time ST elevation acute myocardial infarction (STEMI). Methods A total of 238 patients (mean age 64.6 years) with a first-time STEMI treated with reperfusion therapy were enrolled in our study. Twenty four hours after admission, standard 2D echocardiography and 3D full volume imaging were obtained and strain parameters (GLS: global longitudinal strain, GCS: global circumferential strain) were calculated using 4D LV analysis. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after onset. We followed them for median 94 months (inter quartile range: 69–109 months). The primary end point was the major adverse cardiac and cerebrovascular events (MACE: cardiac death, non-fatal MI, heart failure requiring intravenous diuretics administration and stroke). The patients with persistent chronic atrial fibrillation, poor image quality, emergency bypass surgery were excluded. Results During follow up periods, 78 patients experienced MACE (26 cardiac death, 48 heart failure, 29 non-fatal MI, 5 stroke) and 48 patients died (22 non-cardiac death). In multivariate analysis, 3D-GLS was the strongest predictor for MACE. Kaplan-Meier Curve demonstrated that 3D-GLS >−11.4 was the independent predictor for MACE (Log-rank χ2=73.818, p<0.0001). When combined with 3D-GCS >−19.2, the patients with higher value both of 3D-GLS and 3D-GCS were extremely high risk. The figure shows the Kaplan-Meier curve according to the 4 groups based on the cut-off values determinded by ROC curves. Conclusions Global strain estimated by 3D-STE immediately onset of STEMI was useful tool for the prediction of long term prognosis. Acknowledgement/Funding None