Global longitudinal speckle-tracking strain is predictive of left ventricular remodeling after coronary angioplasty in patients with recent non-ST elevation myocardial infarction.
OBJECTIVE
To test whether two-dimensional longitudinal strain (2DSE) performed after revascularization by percutaneous coronary intervention (PCI) could predict left ventricular (LV) remodeling in patients with recent non-ST elevation myocardial infarction (NSTEMI).


METHODS
In 70 patients (62.7 ± 8.7 years) with recent NSTEMI (between 72 hours and 14 days), undergoing coronary angiography for recurrent angina, myocardial deformation parameters were measured by 2DSE before and 24 hours after reperfusion therapy. Strain in all LV segments was averaged to obtain a global value (Global longitudinal Strain--GLS). Infarct size was estimated by clinical parameters and cardiac markers. After 6 months from intervention, LV negative remodeling was defined as lack of improvement of LV function, with increase in LV end-diastolic volume of greater than or equal than 15%.


RESULTS
At follow-up, patients were subdivided into remodeled (n=32) and non-remodeled (n = 38) groups. Patients with negative LV remodeling had significantly lower baseline LV ejection fraction (44.8±6.9 vs. 48.7 ± 5.5 %; p < 0.05), higher peak troponin I (p < 0.001) and reduced GLS (- 10.6±6.1 vs - 17.6 ± 6.7 % p < 0.001) than those without LV remodeling. GLS showed a close correlation with peak troponin I after PCI (r = 0.64, P < 0.0001) and LV WMSI (r = 0.42, p < 0.01). By multivariable analysis, diabetes mellitus (P < 0.005), peak of Troponin I after PCI (P < 0.0005), GLS at baseline (OR: 4.3; p < 0.0001), and lack of improvement of GLS soon after PCI (OR: 1.45, P < 0.01) were powerful independent predictors of negative LV remodelling at follow-up. In particular, a GLS ≤ 12 % showed a sensitivity and a specificity respectively of 84.8% and 87.8% to predict negative LV remodelling at follow-up.


CONCLUSIONS
in patients with recent NSTEMI, longitudinal LV global and regional speckle-tracking strain measurements are powerful independent predictors of LV remodeling after reperfusion therapy.
D'Andrea
Antonello
A
Chair of Cardiology - Second University of Naples, Italy. antonellodandrea@libero.it
Cocchia
Rosangela
R
Caso
Pio
P
Riegler
Lucia
L
Scarafile
Raffaella
R
Salerno
Gemma
G
Golia
Enrica
E
Di Salvo
Giovanni
G
Calabrò
Paolo
P
Bigazzi
Maurizio Cappelli
MC
Liccardo
Biagio
B
Esposito
Nicolino
N
Cuomo
Sergio
S
Bossone
Eduardo
E
Russo
Maria Giovanna
MG
Calabrò
Raffaele
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*