Impact of Three-Dimensional Strain on Major Adverse Cardiovascular Events after Acute Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention-A Pilot Study.

Raluca Tomoaia,Ioan Alexandru Minciună,Mircea Ioachim Popescu,Dumitru Zdrenghea,Radu Roșu,Dana Pop,Alexandra Dădârlat-Pop,Gabriel Gușetu,Ruxandra Ștefana Beyer,Gabriel Cismaru,Bogdan Caloian,Adela Mihaela Șerban,Maria Ioana Chețan,Gelu Radu Simu

doi:10.3390/life11090930

Abstract

Background: Three-dimensional speckle-tracking echocardiography (3D-STE) allows simultaneous assessment of multidirectional components of strain. However, there are few data on its usefulness to predict prognosis in patients with acute myocardial infarction (AMI). The objective of our pilot study was to evaluate the prognostic value of four different 3D-STE parameters (global longitudinal strain (GLS-3D), global circumferential strain (GCS-3D), global radial strain (GRS-3D), and global area strain (GAS)) in AMI, after successful revascularization by primary PCI. Methods: We enrolled 94 AMI patients (66 ± 13 years, 56% men) who underwent coronary angiography. All patients had been 3D-STE assessed and followed-up for 1 year for the occurrence of MACE. Results: A total of 25 MACE were recorded over follow-up. Cut-off values of −17% for GAS (HR = 3.1, 95% CI: 1.39–6.92, p = 0.005), −12% for GCS-3D (HR = 3.06, 95% CI: 1.36–6.8, p = 0.006), −10% for GLS-3D (HR = 3.04, 95% CI: 1.36–6.78, p = 0.006), and 25% for GRS-3D (HR = 2.89, 95% CI: 1.29–6.46, p = 0.009) showed moderate accuracy in MACE prediction. Multivariate regression showed that GAS (HR = 1.1, 95% CI: 1.03–1.16), GLS-3D (HR = 1.13, 95% CI: 1.03–1.26), and GCS-3D (HR = 1.13, 95% CI: 1.03–1.23) remained independent predictors of MACE (HR = 1.07, 95% CI: 1.01–1.14 for GAS, and HR = 1.1, 95% CI: 1.01–1.2 for GCS-3D). However, post hoc power analysis indicated adequate sample size (power of 80%) only for GAS and GCS-3D for the ROC curve analysis and for GAS, GCS-3D, and GRS-3D for the log-rank test. Conclusion: Patients with AMI might benefit from early risk stratification with the aid of 3D-STE measurements, particularly GAS and GCS-3D, but larger studies are necessary to determine the optimal cut-off values to predict MACE.

Highlights

The increased use of reperfusion strategies consisting of primary percutaneous coronary intervention (PCI) and antithrombotic therapy has improved survival in patients with acute myocardial infarction (AMI)
The goal of our study was to determine the prognostic value of 3D-STE parameters in the prediction of clinical outcomes of patients with AMI undergoing successful PCI and we demonstrated that GLS-3D, GCS-3D, GAS, and GRS-3D were significantly associated with a 3-fold increase in the risk of major adverse cardiovascular events (MACE)
We found in our pilot study that the cut-off value of GAS showing highest sensitivity and specificity in the prediction of MACE was of −17%, which was associated with a 3.1-fold increase in MACE

Summary

Introduction

The increased use of reperfusion strategies consisting of primary percutaneous coronary intervention (PCI) and antithrombotic therapy has improved survival in patients with acute myocardial infarction (AMI). Two-dimensional speckle-tracking echocardiography (2D-STE) imaging overcomes geometric assumptions that might limit the use of standard LVEF and provides a detailed analysis of myocardial deformation, leading to a better understanding of cardiac mechanics [5,6]. Both global longitudinal (GLS) and circumferential (GCS) strains have demonstrated a prognostic role after AMI and might be superior to standard LVEF in the prediction of cardiac events [7,8]. As myocardial mechanics involves multidirectional axes of motion, 2D-STE measurements are limited by the tracking of the speckles in a single plane.

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