Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index: a clinical follow-up study

Abstract

Objective To explore the prognostic value of speckle tracking imaging (STI) for left ventricular remodeling(LVR) in acute myocardial infarction (AMI) patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI). Methods Eighty-three patients with first onset AMI were enrolled from January 2012 to May 2015 and underwent echocardiography within 24 h of the onset and at 6-month follow-up. LVR was defined as more than 20% of the percentage change of left ventricular end-diastolic volume (ΔLVEDV%) from baseline to 6-month follow-up (divided as LVR and non-LVR group). Standard long-axis and short-axis views were stored and analyzed for longitudinal (LS), radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI. Segments of WMSI≥2 were selected and calculated for the mean values of LS (LS_WMSI), RS (RS_WMSI) and CS (CS_WMSI). Results LVR occurred in twenty-seven AMI patients at 6-month follow-up. No difference has shown for demographics, electrocardiogram, lab tests, coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline, while all STI metrics had statistical difference when the comparisons (P<0.05, all), especially the WMSI selected STI metrics (P<0.001, all). Linear regression analysis demonstrated that CS_WMSI (r=0.716, P<0.001) was best correlated to ΔLVEDV% among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6%, specificity of 87.5% and area under the curve of 0.9563). Conclusions Baseline STI metrics can precisely predict LVR at 6-month follow-up. Among the STI metrics, CS_WMSI has shown preferable predictive and diagnostic value, which indicates that the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction. Key words: Echocardiography; Myocardial infarction; Speckle tracking imaging; Ventricular remodeling