title: Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography for prediction of global and segmental functional changes after acute myocardial infarction: a comparison with late gadolinium enhancement cardiac magnetic resonance.
abstract: BACKGROUND
  Myocardial deformation analysis by speckle-tracking echocardiography (STE) has been shown to accurately predict viability in patients with chronic ischemic left ventricular (LV) dysfunction. The aim of this study was to evaluate two-dimensional STE for the prediction of global and segmental LV functional changes after acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR).
  
  
  METHODS
  In 93 patients (mean age, 60 ± 11 years) with first AMIs (55 with ST-segment elevation myocardial infarctions and 38 with non-ST-segment elevation myocardial infarctions) treated with acute percutaneous coronary intervention, global peak longitudinal strain was determined to describe global function by STE, and peak systolic circumferential and longitudinal strain was determined for segmental function analysis. LGE CMR was performed to define the amounts of global and segmental myocardial scar. STE and LGE CMR were performed within 48 hours of AMI. At 6-month follow-up, transthoracic echocardiography was repeated to determine global und segmental LV recovery and adverse LV remodeling (increase in end-systolic volume > 15%).
  
  
  RESULTS
  Accuracy to predict global functional improvement as well as LV remodeling at 6-month follow-up after AMI was similar for STE and LGE CMR (areas under the curve, 0.715 vs 0.729 [P = .8830] and 0.806 vs 0.824 [P = .7141], respectively). Peak systolic circumferential strain < -14.2% had sensitivity of 71.6% and specificity of 58.1% to predict segmental functional improvement. Compared with LGE CMR, the predictive accuracy of transmural STE for segmental functional improvement at 6-month follow-up was lower (area under the curve, 0.788 vs 0.668; P = .0001). Predictive accuracy for segmental functional improvement could be improved by analysis of endocardial circumferential strain (area under the curve, 0.700 vs 0.668 for transmural speckle-tracking echocardiographic analysis; P = .0023).
  
  
  CONCLUSIONS
  Two-dimensional STE allows the prediction of global functional recovery as well as LV remodeling after AMI with accuracy comparable with that of LGE CMR. Accuracy to predict segmental functional recovery using transmural deformation analysis by two-dimensional STE is inferior compared with LGE CMR but can be improved by a layer-specific analysis of endocardial deformation.
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ertunc
authors.initials: E
authors.lastname: Altiok
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Tiemann
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Koos
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Zwicker
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Schroeder
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Kraemer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schoth
authors.affiliation: Department of Biomedical Engineering, University of Haifa, Haifa, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Adam
authors.affiliation: Department of Biomedical Engineering, University of Haifa, Haifa, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Friedman
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.affiliation: Department of Cardiology, Pneumology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany. Electronic address: rhoffmann@ukaachen.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006244:Hardness; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Acute myocardial infarction; Cardiac magnetic resonance; Echocardiography; Left ventricular function; Myocardial contraction