Early prediction of infarct size by strain Doppler echocardiography after coronary reperfusion.
OBJECTIVE
The objective of this study was to investigate whether strain Doppler echocardiography performed immediately after revascularization by percutaneous coronary intervention could predict the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging (MRI).


BACKGROUND
There is considerable variability in survival rate after percutaneous coronary intervention, and accurate early risk stratification is therefore of major clinical importance.


METHODS
Thirty individuals with acute anterior myocardial infarction were examined with longitudinal strain by Doppler 1.5 h after revascularization. The extent of scarring 9 months later was analyzed by MRI in 16 corresponding myocardial segments. Strain in all left ventricular segments was averaged to obtain a global value. Infarct size was estimated by clinical parameters and cardiac markers.


RESULTS
A good correlation was found between the global strain and total infarct size (R = 0.77, p < 0.00001). A multivariate regression analysis showed that global peak strain and serum glutamic oxaloacetic transaminase correlated with the infarct size measured by MRI (p = 0.0001 and p = 0.001, respectively). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment (R = 0.67, p < 0.0001).


CONCLUSIONS
This study demonstrates that assessment of regional and global strain at 1.5 h after reperfusion therapy correlates with size and transmural extent of myocardial infarction as determined by contrast-enhanced MRI. The novel global strain parameter is a valuable predictor of the total extent of myocardial infarction and may therefore be an important clinical tool for risk stratification in the acute phase of myocardial infarction.
Vartdal
Trond
T
Department of Cardiology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
Brunvand
Harald
H
Pettersen
Eirik
E
Smith
Hans-Jørgen
HJ
Lyseggen
Erik
E
Helle-Valle
Thomas
T
Skulstad
Helge
H
Ihlen
Halfdan
H
Edvardsen
Thor
T
D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016277:Ventricular Function, Left