Prognostic Value of Longitudinal Strain After Primary Reperfusion Therapy in Patients with Anterior-wall Acute Myocardial Infarction

Abstract

We sought to test whether longitudinal strain (LS) can be a useful predictor of left ventricular (LV) remodeling after reperfusion therapy in acute myocardial infarction. Predicting LV remodeling based on quantification of regional contractility remains an elusive goal of echocardiography. In 50 patients with anterior-wall acute myocardial infarction, the peak systolic velocity and LS were measured by Doppler tissue imaging (LS(DTI)) and speckle tracking imaging (LS(2D)) at 7 LV segments of left anterior descending coronary artery territory after primary reperfusion therapy. LV remodeling was defined as an increase in LV end-diastolic volume of greater than or equal to 15% at follow-up echocardiography. A total of 22 patients showed LV remodeling, who had significantly lower baseline ejection fraction, LS(DTI), and LS(2D), and higher wall-motion score index and peak creatine kinase-MB with shorter deceleration time of early diastolic mitral inflow than those without LV remodeling. LS(2D) (odds ratio [OR] = 1.307, 95% confidence interval [CI] = 1.082-1.579, P = .005) and LS(DTI) (OR = 1.430, 95% CI = 1.152-1.776, P = .001) were independent predictors of LV remodeling. During clinical follow-up of 18.3 +/- 9.0 months, death or congestive heart failure developed in 11 patients (22%); LS(2D) (OR = 1.455, 95% CI = 1.142-1.852, P = .002) and LS(DTI) (OR = 1.436, 95% CI = 1.093-1.888, P = .009) were independent predictors. LS immediately after primary reperfusion therapy is an excellent predictor of LV remodeling and adverse events in patients with anterior-wall acute myocardial infarction.