title: Value of apical circumferential strain in the early post-myocardial infarction period for prediction of left ventricular remodeling.
abstract: BACKGROUND
  Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is related to increased morbidity and mortality. The aim of the present study was to examine whether LV deformational and torsional parameters can predict LV remodeling in patients with AMI.
  
  
  METHODS
  Forty-two patients (age 57 ± 14 years) presenting with an anterior ST-elevation AMI and treated with primary percutaneous transluminal coronary angioplasty (PTCA) were included in the study. Four days post MI, LV ejection fraction (EF), LV torsion, longitudinal (4-, 3- & 2-chamber) and circumferential strain of the LV apex were evaluated by conventional and speckle-tracking echocardiography. The echocardiographic study was repeated at 3 months post-AMI and patients with LV remodeling, i.e. an increase >15% in LV end-systolic volume (LVESV), were identified.
  
  
  RESULTS
  The 13 patients with LV remodeling had significantly more impaired apical circumferential strain (-7.3 ± 2.2% vs. -18.9 ± 5.2%, p=0.001), EF (42 ± 7% vs. 48.9 ± 6%, p=0.005), LV apical rotation (6.8 ± 4.8° vs. 11.1 ± 4.0°, p=0.027), and LV global longitudinal strain (-9.7 ± 1.9% vs. -12.9 ± 2.9%, p=0.03) on the 4th day post-AMI, in comparison to those without LV remodeling. Apical circumferential strain on the 4th day post-AMI showed the strongest correlation with the LVESV 3 months post-AMI (r=0.76, p=0.001), compared to EF (r=-0.60, p=0.001), global longitudinal strain (r=0.56, p=0.001), and LV apical rotation (r=-0.53, p=0.001). Furthermore, apical circumferential strain demonstrated the highest diagnostic accuracy: area under the receiver operating characteristic (ROC) curve 0.98, with sensitivity 100% and specificity 96% for prediction of LV remodeling, using a cutoff value <-11.0%.
  
  
  CONCLUSIONS
  In patients with anterior AMI, LV apical circumferential strain in the early post-MI period constitutes a significant prognostic factor for LV remodeling at 3 months. Assessment of this parameter may identify patients at high risk for heart failure development.
authors.affiliation: Third Cardiology Department, Medical School, University of Athens, Athens, Greece Drs. Bonios and Kaladaridou contributed equally to this work.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bonios
authors.forename: Anna
authors.initials: A
authors.lastname: Kaladaridou
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tasoulis
authors.forename: Electra
authors.initials: E
authors.lastname: Papadopoulou
authors.forename: Constantinos
authors.initials: C
authors.lastname: Pamboukas
authors.forename: Argirios
authors.initials: A
authors.lastname: Ntalianis
authors.forename: John
authors.initials: J
authors.lastname: Kanakakis
authors.forename: John V
authors.initials: JV
authors.lastname: Terrovitis
authors.forename: Savvas T
authors.initials: ST
authors.lastname: Toumanidis
mesh_terms: D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling