Prediction of global and segmental functional changes after acute myocardial infarction by 2D speckle-tracking echocardiography and cardiac magnetic resonance imaging

Abstract

Purpose: Myocardial deformation analysis by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been shown to accurately predict viability in patients with chronic ischemic LV dysfunction. This study evaluated STE for prediction of global and segmental left ventricular (LV) functional changes after acute myocardial infarction (AMI) in comparison with late gadolinium enhancement cardiac magnetic resonance (LGE). Methods: In 93 patients (60±11 years) with first AMI (55 with ST-segment elevation myocardial infarction (STEMI) and 38 with Non-ST-segment elevation myocardial infarction (NSTEMI)), all treated by acute percutaneous coronary intervention peak global longitudinal strain was determined to describe global function by STE and peak systolic circumferential strain was determined for segmental function analysis. LGE was performed to define the amount of global and segmental myocardial scar. STE and LGE were performed within 48 hours after AMI. At 6 months follow-up transthoracic echocardiography was repeated to determine global (increase of ejection fraction ≥5%) and segmental (improvement of wall motion score at least one grade) LV recovery as well as global LV remodeling (increase of end-systolic volume >15%). Results: Accuracy to predict global functional improvement and LV remodeling at 6 months follow-up after AMI was similar for STE vs. LGE (AUC=0.715 vs. AUC=0.729, p=0.8830 and AUC=0.806 vs. AUC=0.824; p=0.7141, respectively). In patients with STEMI accuracy of circumferential strain analysis by STE to predict segmental functional improvement was non-inferior compared to analysis of LGE (AUC=0.679 vs. AUC=0.755; p=0.0512), while in patients with NSTEMI accuracy of strain analysis by STE for prediction of segmental functional improvement was lower compared to LGE (AUC=0.666 vs. AUC=0.838; p=0.0004). Conclusions: In patients with AMI, accuracy to predict global functional recovery as well as LV remodeling by 2D STE is comparable to LGE. In patients with STEMI, myocardial deformation analysis by 2D STE allows prediction of segmental functional recovery with non-inferior accuracy compared to LGE, while accuracy to predict segmental functional improvement is less in patients with NSTEMI.