Abstract 2208: Role of Longitudinal and Circumferential Strain Rate in the Prediction of Left Ventricular Remodeling and Prognosis After Myocardial Infarction: The VALIANT Study
Longitudinal and circumferential strain rate (SR) are reduced with increasing infarct size after acute MI. Longitudinal SR has been shown to be a powerful predictor of outcome. We investigated the clinical value of both measures as predictors of ventricular remodeling in high-risk MI. The VALIANT echo study enrolled 603 patients with LV dysfunction, heart failure (HF), or both 5 days after MI. Peak longitudinal systolic SR (SRs) was measured from apical 2-and 4-chamber views with circumferential SRs from short axis midwall using speckle tracking software (Velocity Vector Imaging, Siemens, Inc.). LV remodeling was defined as at least 15% increase of end-systolic volume at 20 months follow-up. Multivariable and logistic regression models were used to predict outcomes and remodeling. Longitudinal SRs was available in 380 cases (−5.1±1.6 100/ms) and circumferential SRs available in 420 cases (−8.0±2.8 100/ms) with 311 cases having both measures. Both longitudinal and circumferential SRs were predictive of death or HF (HR 2.4, 95% CI 2.0 –3.1, P<0.001; HR 1.3, 95% CI 1.2–1.4, P<0.001) after adjustment for clinical covariates. With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (OR 1.3, 95% CI 1.1–1.5, P<0.001). While both longitudinal and circumferential systolic SR were predictive of outcomes after MI, only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function may serve to restrain ventricular enlargement post-MI.