Abstract 12462: Global Longitudinal Strain Estimated by 3D Speckle Tracking Acutely After Onset of ST-Elevation Myocardial Infarction is Useful to Predict Final Infarct Size and Left Ventricular Remodeling
Background: Left ventricular (LV) global strain estimated immediately after ST elevation AMI (STEMI) was reported as a predictor of LV remodeling. However, strain analysis ideally should be assessed by 3D speckle tracking, in order to avoid through plane motion. We explored the usefulness of global strain estimated by 3D speckle tracking in patients with a first STEMI in comparison with other well-known parameters (e.g., E/e’, LA volume index, and EF).
Methods: Subjects were 168 consecutive patients (131 men, age 65 years, peak CPK=3169±3817 IU/l) presenting with a first ST-elevation AMI (STEMI) who underwent primary PCI within 12 hours of onset. Within 24 h of PCI, 2D and 3D speckle tracking echocardiography were performed by E33 and the newest Q-lab version 9.0 (CMQ, Philips). 3D speckle tracking was analyzed by 4D LV-Analysis (TOM-TEC, Germany). Global longitudinal strain (GLS) was calculated both by 3D (3D-GLS) and 2D (2D-GLS) speckle tracking. 2D-GLS was measured using 3ch, 4ch and 2ch views. Final infarct size was defined using Tc99m-sestamibi as the total area of ≤50%uptake area at 2 weeks. Echocardiography was repeated 12 months later and LV remodeling was defined as an absolute increase in LVEDV of more than 20%. The patients with Af, HD, prior MI, and emergency CABG were excluded.
Results: 3D-GLS, 2D-GLS, EF, and E/e’ had significant correlations with infarct size (3D-GLS, 2D-GLS, E/e’; r=0.55, 0.48, 0.5, 0.45, respectively, all p≤0.0001), but LA volume index did not. LV remodeling was observed in 49 patients at 12 months. (Table) Multivariate analysis showed that 3D-GLS was the strongest predictor for LV remodeling.
Conclusions: In patients with a first STEMI, GLS assessed by 3D speckle tracking echocardiography immediately after PCI can predict final infarct size and LV remodeling. This parameter, obtained immediately after PCI, might be superior to the other well-known parameters, including E/e’ in predicting the LV remodeling.
- © 2013 by American Heart Association, Inc.