Prediction of left ventricular remodelling after acute myocardial infarction by 3D strain echocardiography

Abstract

Background: Left ventricular (LV) remodeling has been shown to be related mainly to myocardial infarction (MI) size. We aimed to analyze the respective predictive value of 3D strain parameters, including area strain and biomarkers for the development of early LV remodeling at 30 days after acute MI. Methods: 34 patients with a first MI underwent 3D echocardiography at 2 and 30 days after reperfusion. LV remodeling was defined as an increase in LV end-diastolic volume (EDV, ml) >15% from baseline values. LV volumes (ml), wall motion score index (WMSI), LV ejection fraction (LVEF, %), area strain (AS, %), global longitudinal (GLS, %), circumferential (GCS, %), and radial (GRS, %) strains were correlated with the relative change in EDV (%) at 30 days. Results: At 30 days, LV remodeling was present in 12 patients (35%). Peak values of Troponin (TN, mcg/L) (68 [43-146] vs. 34 [15-107], p=0.2) and creatine phosphokinase (CPK, U/L) (2312 [1717-4075] vs. 1452 [615-2848], p=0.08) were similar in the remodeling and in the non-remodeling groups. LVEF similarly increased in remodeling (47±10% to 56±8%) and in non remodeling (50±7% to 57±6%) groups (p<0.05). At baseline, both LVEF and WMSI were similar in remodeling vs non remodeling group. Among the 3D strain values, GLS was the only strain parameter to be significantly lower in remodeling group (p<0.03) (table). At one month, changes in LVEDV correlated with baseline values of WMSI (r=0.45, p=0.007), GLS (r=0.48, p<0.004), GCS (r=0.42, p<0.01), GRS (r=-0.39, p=0.02), and AS (r=0.47, p<0.006). At multivariate analysis, GLS was the only parameter predictive of remodeling with a cut-off value of -12% by ROC curve analysis (AUC=0.71[0.53-0.89], CI95%) with a sensitivity of 83% and specificity of 59%. View this table: Conclusions: Among all 3D strain parameters, global longitudinal strain appears to be the most accurate deformation parameter to predict early LV remodeling after acute myocardial infarction