Temporal deformation pattern in acute and late phases of ST-elevation myocardial infarction: incremental value of longitudinal post-systolic strain to assess myocardial viability.
BACKGROUND
Identification of transmural extent and degree of non-viability after ST-segment elevation myocardial infarction (STEMI) is clinically important. The objective of the present study was to assess the regional mechanics and temporal deformation patterns using speckle tracking echocardiography (STE) in acute and later phases of STEMI to predict myocardial damage in these patients.


RESULTS
Ninety-eight patients with first STEMI underwent both echocardiography and cardiac magnetic resonance imaging in acute phase and at 6 months follow-up with 2D STE-derived measurements of peak longitudinal strain (PLS), Pre-STretch index (PST) and post-systolic deformation index (PSI). For each segment, late gadolinium enhancement (LGE) was defined as transmural (LGE >66 %) or non-transmural (<66 %). Global deformation values were significantly correlated with LVEFCMR and infarct size at both visits. A significantly lower value of segmental PLS and higher PSI and PST in necrotic segments were observed comparatively to control, adjacent and remote segments. The best parameters to predict transmural extent in acute phase were PSI with a cutoff value of 8 % (AUC: 0.84) and PLS with a cutoff value of -13 % (AUC: 0.86). PST showed high specificity, but poor sensitivity in predicting transmural extent. More importantly, the addition of PSI and PST to PLS in acute phase was associated with improved prediction of viability at 6 months (integrated discrimination improvement 2.5 % p < 0.01; net reclassification improvement 27 %; p < 0.01).


CONCLUSIONS
All systolic deformation values separated transmural from non-transmural scarring. PLS combined with additional information relative to post-systolic deformation appears to be the most informative parameters to predict the transmural extent of MI in the early and late phases of MI.


BACKGROUND
http://clinicaltrials.gov/show/NCT01109225 ; NCT01109225.
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France. o.huttin@chu-nancy.fr.
Olivier
O
Huttin
Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Pierre-Yves
PY
Marie
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France.
Maxime
M
Benichou
INSERM Centre d'Investigation Clinique CIC-P 9501, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Erwan
E
Bozec
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France.
Simon
S
Lemoine
Centre d'Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Damien
D
Mandry
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France.
Yves
Y
Juillière
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France.
Nicolas
N
Sadoul
Centre d'Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Emilien
E
Micard
INSERM Centre d'Investigation Clinique CIC-P 9501, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Kevin
K
Duarte
Centre d'Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Marine
M
Beaumont
INSERM Centre d'Investigation Clinique CIC-P 9501, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Patrick
P
Rossignol
INSERM Centre d'Investigation Clinique CIC-P 9501, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France.
Nicolas
N
Girerd
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France.
Christine
C
Selton-Suty
D000368:Aged; D001696:Biomechanical Phenomena; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D005602:France; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D013314:Stress, Mechanical; D013997:Time Factors; D014022:Tissue Survival; D016277:Ventricular Function, Left
D003287:Contrast Media
Deformation mechanics; Echocardiography; Left ventricular function; Myocardial infarction; Strain