title: Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction.
abstract: OBJECTIVE
  We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI).
  
  
  BACKGROUND
  Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions.
  
  
  METHODS
  The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes.
  
  
  RESULTS
  Both longitudinal (mean: -5.1 ± 1.6 100/ms) and circumferential SRs (mean: -8.0 ± 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001).
  
  
  CONCLUSIONS
  Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.forename: Anil
authors.initials: A
authors.lastname: Verma
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Shin
authors.forename: Mikhail
authors.initials: M
authors.lastname: Bourgoun
authors.forename: Amira H
authors.initials: AH
authors.lastname: Hassanein
authors.forename: John J
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D011379:Prognosis; D014463:Ultrasonography; D020257:Ventricular Remodeling