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Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction

Echo Research & Practice volume 6, pages 81–89 (2019)Cite this article

Abstract

The aim of this study was to investigate if there was an association between infarct size (IS) measured by cardiac magnetic resonance (CMR) and echocardiographic global longitudinal strain (GLS) in the early stage of acute myocardial infarction in patients with preserved left ventricular ejection fraction (LVEF). Patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were assessed with CMR and transthoracic echocardiogram within 1 week of hospital admission. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 17-segment model covering the entire left ventricular myocardium. GLS was calculated automatically. LVEF was measured by auto-LVEF in EchoPac. IS was measured by late gadolinium enhancement CMR in short-axis views covering the left ventricle. The study population consisted of 49 patients (age 60.4 ± 9.7 years; 92% male). The study population had preserved echocardiographic LVEF with a mean of 45.8 ± 8.7%. For each percent increase of IS, we found an impairment in GLS by 1.59% (95% CI 0.57–2.61), P = 0.02, after adjustment for sex, age and LVEF. No significant association between IS and echocardiographic LVEF was found: −0.25 (95% CI: −0.61 to 0.11), P = 0.51. At the segmental level, the strongest association between IS and longitudinal strain was found in the apical part of the LV: impairment of 1.69% (95% CI: 1.14–2.23), P < 0.001, for each percent increase in IS. In conclusion, GLS was significantly associated with IS in the early stage of acute myocardial infarction in patients with preserved LVEF, and this association was strongest in the apical part of the LV. No association between IS and LVEF was found.

References

  1. Pfeffer MA & Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990 1161–1172. https://doi.org/10.1161/01.cir.81.4.1161)

    Google Scholar 

  2. Gaudron P, Eilles C, Kugler I & Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation 1993 755–763. https://doi.org/10.1161/01.cir.87.3.755)

    Google Scholar 

  3. St John Sutton M, Lee D, Rouleau JL, Goldman S, Plappert T, Braunwald E & Pfeffer MA. Left ventricular remodeling and ventricular arrhythmias after myocardial infarction. Circulation 2003 2577–2582. https://doi.org/10.1161/01.CIR.0000070420.51787.A8)

    Google Scholar 

  4. Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M & Judd RM. Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation 2001 1101–1107. https://doi.org/10.1161/hc3501.096798)

    Google Scholar 

  5. Christian TF, Schwartz RS & Gibbons RJ. Determinants of infarct size in reperfusion therapy for acute myocardial infarction. Circulation 1992 81–90. https://doi.org/10.1161/01.cir.86.1.81)

    Google Scholar 

  6. Eitel I, De Waha S, Wöhrle J, Fuernau G, Lurz P, Pauschinger M, Desch S, Schuler G & Thiele H. Comprehensive prognosis assessment by CMR imaging after ST-segment elevation myocardial infarction. Journal of the American College of Cardiology 2014 1217–1226. https://doi.org/10.1016/j.jacc.2014.06.1194)

    Google Scholar 

  7. El Aidi H, Adams A, Moons KGM, Den Ruijter HM, Mali WPTM, Doevendans PA, Nagel E, Schalla S, Bots ML & Leiner T. Cardiac magnetic resonance imaging findings and the risk of cardiovascular events in patients with recent myocardial infarction or suspected or known coronary artery disease: a systematic review of prognostic studies. Journal of the American College of Cardiology 2014 1031–1045. https://doi.org/10.1016/j.jacc.2013.11.048)

    Google Scholar 

  8. Heydari B, Jerosch-Herold M & Kwong RY. Assessment of myocardial ischemia with cardiovascular magnetic resonance. Progress in Cardiovascular Diseases 2011 191–203. https://doi.org/10.1016/j.pcad.2011.09.004)

    Google Scholar 

  9. Bøtker HE, Kaltoft AK, Pedersen SF & Kim WY. Measuring myocardial salvage. Cardiovascular Research 2012 266–275. https://doi.org/10.1093/cvr/cvs081)

    Google Scholar 

  10. Von Knobelsdorff-Brenkenhoff F & Schulz-Menger J. Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology. Journal of Cardiovascular Magnetic Resonance 2016 6. https://doi.org/10.1186/s12968-016-0225-6)

    Google Scholar 

  11. Bruder O, Wagner A, Lombardi M, Schwitter J, Van Rossum A, Pilz G, Nothnagel D, Steen H, Petersen S, Nagel E, et al. European cardiovascular magnetic resonance (EuroCMR) registry–multi national results from 57 centers in 15 countries. Journal of Cardiovascular Magnetic Resonance 2013 9. https://doi.org/10.1186/1532-429X-15-9)

    Google Scholar 

  12. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, et al. ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal 2015 2015 2793–2867. https://doi.org/10.1093/eurheartj/ehv316)

    Article  Google Scholar 

  13. Shiga T, Hagiwara N, Ogawa H, Takagi A, Nagashima M, Yamauchi T, Tsurumi Y, Koyanagi R, Kasanuki H & Heart Institute of Japan. Sudden cardiac death and left ventricular ejection fraction during long-term follow-up after acute myocardial infarction in the primary percutaneous coronary intervention era: results from the HIJAMI-II registry. Heart 2009 216–220. https://doi.org/10.1136/hrt.2008.145

  14. Solomon SD, Zelenkofske S, McMurray JJ, Finn PV, Velazquez E, Ertl G, Harsanyi A, Rouleau JL, Maggioni A, Koberl L, et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. New England Journal of Medicine 2005 2581–2588. https://doi.org/10.1056/NEJMoa043938)

    Google Scholar 

  15. Medvedofsky D, Kebed K, Laffin L, Stone J, Addetia K, Lang RM & Mor-Avi V. Reproducibility and experience dependence of echocardiographic indices of left ventricular function: side-by-side comparison of global longitudinal strain and ejection fraction. Echocardiography 2017 365–370. https://doi.org/10.1111/echo.13446)

    Google Scholar 

  16. Cimino S, Canali E, Petronilli V, Cicogna F, De Luca L, Francone M, Sardella G, Iacoboni C & Agati L. Global and regional longitudinal strain assessed by two-dimensional speckle tracking echocardiography identifies early myocardial dysfunction and transmural extent of myocardial scar in patients with acute ST elevation myocardial infarction and relatively preserved LV function. European Heart Journal Cardiovascular Imaging 2013 805–811. https://doi.org/10.1093/ehjci/jes295)

    Google Scholar 

  17. Diao KY, Yang ZG, Ma M, He Y, Zhao Q, Liu X, Gao Y, Xie LJ & Guo YK. The diagnostic value of global longitudinal strain (GLS) on myocardial infarction size by echocardiography: a systematic review and meta-analysis. Scientific Reports 2017 10082. https://doi.org/10.1038/s41598-017-09096-2)

    Google Scholar 

  18. Shetye A, Nazir SA, Squire IB & McCann GP. Global myocardial strain assessment by different imaging modalities to predict outcomes after ST-elevation myocardial infarction: a systematic review. World Journal of Cardiology 2015 948–960. https://doi.org/10.4330/wjc.v7.i12.948)

    Google Scholar 

  19. Ersbøll M, Valeur N, Andersen MJ, Mogensen UM, Vinther M, Svendsen JH, Moller JE, Kisslo J, Velazquez EJ, Hassager C, et al. Early echocardiographic deformation analysis for the prediction of sudden cardiac death and life-threatening arrhythmias after myocardial infarction. JACC: Cardiovascular Imaging 2013 851–860. https://doi.org/10.1016/j.jcmg.2013.05.009)

    Google Scholar 

  20. Edvardsen T & Haugaa KH. Strain echocardiography: from variability to predictability. JACC: Cardiovascular Imaging 2017 35–37. https://doi.org/10.1016/j.jcmg.2017.03.012)

    Google Scholar 

  21. Klem I, Heiberg E, Van Assche L, Parker MA, Kim HW, Grizzard JD, Arheden H & Kim RJ. Sources of variability in quantification of cardiovascular magnetic resonance infarct size–reproducibility among three core laboratories. Journal of Cardiovascular Magnetic Resonance 2017 62. https://doi.org/10.1186/s12968-017-0378-y)

    Google Scholar 

  22. Bansal M, Cho GY, Chan J, Leano R, Haluska BA & Marwick TH. Feasibility and accuracy of different techniques of two-dimensional speckle based strain and validation with harmonic phase magnetic resonance imaging. Journal of the American Society of Echocardiography 2008 1318–1325. https://doi.org/10.1016/j.echo.2008.09.021)

    Google Scholar 

  23. Simonetti OP, Kim RJ, Fieno DS, Hillenbrand HB, Wu E, Bundy JM, Finn JP & Judd RM. An improved MR imaging technique for the visualization of myocardial infarction. Radiology 2001 215–223. https://doi.org/10.1148/radiology.218.1.r01ja50215)

    Google Scholar 

  24. Heiberg E, Sjögren J, Ugander M, Carlsson M, Engblom H & Arheden H. Design and validation of segment–freely available software for cardiovascular image analysis. BMC Medical Imaging 2010 1. https://doi.org/10.1186/1471-2342-10-1)

    Google Scholar 

  25. Heiberg E, Ugander M, Engblom H, Götberg M, Olivecrona GK, Erlinge D & Arheden H. Automated quantification of myocardial infarction from MR images by accounting for partial volume effects: animal, phantom, and human study. Radiology 2008 581–588. https://doi.org/10.1148/radiol.2461062164)

    Google Scholar 

  26. Haugaa KH, Grenne BL, Eek CH, Ersbøll M, Valeur N, Svendsen JH, Florian A, Sjoli B, Brunvand H, Kober L, et al. Strain echocardiography improves risk prediction of ventricular arrhythmias after myocardial infarction. JACC: Cardiovascular Imaging 2013 841–850. https://doi.org/10.1016/j.jcmg.2013.03.005)

    Google Scholar 

  27. Haugaa KH, Smedsrud MK, Steen T, Kongsgaard E, Loennechen JP, Skjaerpe T, Voigt JU, Willems R, Smith G, Smiseth OA, et al. Mechanical dispersion assessed by myocardial strain in patients after myocardial infarction for risk prediction of ventricular arrhythmia. JACC: Cardiovascular Imaging 2010 247–256. https://doi.org/10.1016/j.jcmg.2009.11.012)

    Google Scholar 

  28. Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Velazquez EJ, Hassager C, Sogaard P & Kober L. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. Journal of the American College of Cardiology 2013 2365–2373. https://doi.org/10.1016/j.jacc.2013.02.061)

    Google Scholar 

  29. Gjesdal O, Helle-Valle T, Hopp E, Lunde K, Vartdal T, Aakhus S, Smith HJ, Ihlen H & Edvardsen T. Noninvasive separation of large, medium, and small myocardial infarcts in survivors of reperfused ST-elevation myocardial infarction: a comprehensive tissue Doppler and speckle-tracking echocardiography study. Circulation: Cardiovascular Imaging 2008 189–196. https://doi.org/10.1161/CIRCIMAGING.108.784900)

    Google Scholar 

  30. Roes SD, Mollema SA, Lamb HJ, van der Wall EE, de Roos A & Bax JJ. Validation of echocardiographic two-dimensional speckle tracking longitudinal strain imaging for viability assessment in patients with chronic ischemic left ventricular dysfunction and comparison with contrast-enhanced magnetic resonance imaging. American Journal of Cardiology 2009 312–317. https://doi.org/10.1016/j.amjcard.2009.03.040)

    Google Scholar 

  31. Sjøli B, Ørn S, Grenne B, Ihlen H, Edvardsen T & Brunvand H. Diagnostic capability and reproducibility of strain by Doppler and by speckle tracking in patients with acute myocardial infarction. JACC: Cardiovascular Imaging 2009 24–33. https://doi.org/10.1016/j.jcmg.2008.10.007)

    Google Scholar 

  32. Vartdal T, Brunvand H, Pettersen E, Smith HJ, Lyseggen E, Helle-Valle T, Skulstad H, Ihlen H & Edvardsen T. Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion. Journal of the American College of Cardiology 2007 1715–1721. https://doi.org/10.1016/j.jacc.2006.12.047)

    Google Scholar 

  33. Ganame J, Messalli G, Masci PG, Dymarkowski S, Abbasi K, Van De Werf F, Janssens S & Bogaert J. Time course of infarct healing and left ventricular remodelling in patients with reperfused ST segment elevation myocardial infarction using comprehensive magnetic resonance imaging. European Radiology 2011 693–701. https://doi.org/10.1007/s00330-010-1963-8)

    Google Scholar 

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Funding

The region of postgraduate medical education administration office, Viborg, Denmark.

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Authors and Affiliations

  1. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gowsini Joseph MD, Svend Eggert Jensen MD PhD & Peter Sogaard MD DMSc

  2. Department of Cardiology, North Denmark Regional Hospital, Hjorring, Denmark

    Gowsini Joseph MD & Svend Eggert Jensen MD PhD

  3. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

    Gowsini Joseph MD, Tomas Zaremba MD PhD & Peter Sogaard MD DMSc

  4. Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark

    Martin Berg Johansen

  5. Department of Cardiology, Nephrology and Endocrinology, North Zealand Hospital, Hillerod, Denmark

    Sarah Ekeloef MD PhD

  6. Department of Clinical Physiology, Lund University and Skaane University Hospital, Lund, Sweden

    Einar Heiberg MSc PhD & Henrik Engblom MD PhD

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  1. Gowsini Joseph MD
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Correspondence to Gowsini Joseph MD.

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Joseph, G., Zaremba, T., Johansen, M.B. et al. Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction. Echo Res Pract 6, 81–89 (2019). https://doi.org/10.1530/ERP-19-0026

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Echo Research & Practice

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