Study of right ventricular global longitudinal strain imaging in patients of acute inferior wall myocardial infarction and its correlation with in hospital outcome

Abstract OBJECTIVESObjectives of this study were to evaluate right ventricular function using two dimensional speckle tracking echocardiography among patients who were admitted with acute myocardial infarction and treated with primary angioplasty, association between right ventricular strain global longitudinal strain and major adverse cardiovascular events and to analyse the angiographic results of all patients. METHODSThis was a prospective observational study conducted in 200 consecutive patients admitted with acute inferior wall myocardial infarction and treated with primary angioplasty. Right ventricular global longitudinal strain was measured by two dimensional speckle tracking echocardiography and angiographic results of all patients were recorded. All patients were followed up till discharge / death. Categorical data were compared using Chi-square test or Fisher’s exact test. Logistic regression was done to find out the major adverse cardiovascular outcomes predictive by RVGLS. P < 0.05 was considered statistically significant. RESULTS200 patients were enrolled for the study of which were 102 (51%) patients and 98 (49 %) patients were males and females respectively. Patients with low RVGLS had higher incidence of left ventricular dysfunction(P=0..006) ,low TAPSE and S’(P<0.001) ,angiographic triple vessel disease(p<0.001),arrhythmias(p=0.02) ,right heart failure(P<0.001),target lesion revascularisation(P=0.029) and prolonged hospital stay(P<0.001).In multivariate analysis , arrhythmias (P=0.046 ,OR - 2.05, CI 0.93-8.10) ad target lesion revascularisation were the two major adverse cardiovascular events predictive by RVGLS. CONCLUSIONRVGLS could be used a prognostic marker in patients admitted with acute inferior wall infarction, categorise the risk and might assist the interventionist in planning an earliest therapeutic strategy.

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Assessment of left ventricular contractility in acute inferior wall myocardial infarction by speckle tracking echocardiography

Russian Medical Inquiry ◽

10.32364/2587-6821-2021-5-4-169-175 ◽

2021 ◽

Vol 5 (4) ◽

pp. 169-175

Author(s):

E.G. Akramova ◽

◽

Е.V. Vlasova ◽

◽

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Inferior Wall ◽

Ventricular Ejection Fraction

Aim: to assess the results of speckle tracking echocardiography (STE) in patients of working age with acute inferior wall myocardial infarction (MI) in the early period after coronary stenting. Patients and Methods: STE was performed using EPIQ-7 Ultrasound Machine (Philips, USA) in 55 patients with acute inferior wall MI one week after percutaneous coronary intervention and 29 healthy individuals of working age. Patients with acute inferior wall MI were divided into two subgroups, i.e., with (n=45) or without (n=10) areas of local contractile impairment (dyskinesia, akinesia, hypokinesia). Results: the most common cause of MI was the occlusion of the right coronary artery (82.4% in subgroup 1 and 60% in subgroup 2) in multivascular involvement (84.4% and 90%. respectively). In patients with local contractile impairment, reduced left ventricular ejection fraction (EF) was reported in 28.9%, global longitudinal strain in 86.7%, and global circular strain in 76.7%. Meanwhile, in patients without local contractile impairment, left ventricular ejection fraction (LV EF) was within normal ranges, global longitudinal strain was reported in 100% and global circumferential strain in 70%. The presence and severity of local dysfunction did not affect the reduction in segmental strain (median varied from -9% to -15%). In inferior wall MI, the abnormal regional longitudinal strain of 6 LV segments (basal and mid inferoseptal, inferior, and inferolateral) was reported in both hypokinesia and normokinesia. Conclusions: ultrasound evaluation of systolic LV function using STE is characterized by greater diagnostic value compared to the measurement of EF only and objectifies the efficacy of surgery. Quantitative assessment of the recovery of both global and local systolic contractility is another advantage of STE allowing for personalized treatment. KEYWORDS: inferior wall myocardial infarction, echocardiography, speckle tracking technology, percutaneous coronary intervention, ejection fraction. FOR CITATION: Akramova E.G., Vlasova Е.V. Assessment of left ventricular contractility in acute inferior wall myocardial infarction by speckle tracking echocardiography. Russian Medical Inquiry. 2021;5(4):169–175 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-169-175.

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Comparison of pre and post Global longitudinal Strain imaging in thrombolytic and primary percutaneous coronary intervention in acute ST elevation Anterior Myocardial infarction

University Heart Journal ◽

10.3329/uhj.v16i1.44816 ◽

2020 ◽

Vol 16 (1) ◽

pp. 11-15

Author(s):

Mohammad Rayhan Masum Mandal ◽

Syed Ali Ahsan ◽

Harisul Hoque ◽

Mohammad Faisal Ibn Kabir ◽

Khurshed Ahmed ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Coronary Intervention ◽

Strain Imaging ◽

Anterior Myocardial Infarction ◽

Percutaneous Coronary ◽

St Elevation

Abstract not available University Heart Journal Vol. 16, No. 1, Jan 2020; 11-15

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CLINICAL PROFILE AND IN-HOSPITAL OUTCOME OF PATIENTS WITH RIGHT VENTRICULAR MYOCARDIAL INFARCTION IN INFERIOR WALL MYOCARDIAL INFARCTION

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/260 ◽

2017 ◽

Vol 6 (15) ◽

pp. 1193-1199

Author(s):

Ravi Prakash Pandey ◽

Kuwer Devi Singh ◽

Mohsin Bilal ◽

Manzar Hussain Usmani

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Clinical Profile ◽

Inferior Wall ◽

Hospital Outcome ◽

Right Ventricular Myocardial Infarction

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P1535 Interventricular interaction can result in right ventricular dysfunction in interventricular septum involved myocardial infarction patient

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.957 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C S Park ◽

A Gwon ◽

H S Ahn ◽

G H Kim ◽

J S Cho ◽

...

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Longitudinal Strain ◽

Ventricular Dysfunction ◽

Global Longitudinal Strain ◽

Interventricular Septum ◽

Right Ventricular Dysfunction ◽

Free Wall ◽

Right Ventricular Free Wall

Abstract Background Previous studies revealed that interventricular septal thickness is related to right ventricular dysfunction after anterior myocardial infarction. This finding suggest that interventricular septal function can affect right ventricular function in myocardial infarction patients. We assumed that right ventricular free wall strain values measured using dedicated software can be affected in the setting of ischemic insult on interventricular septum in long-term follow up. Methods The patients diagnosed as acute myocardial infarction due to left anterior descending artery disease who underwent successful revascularization were enrolled. Echocardiographic exams were performed at least 2 times, within 72 hours and 1 year after the revascularization. Strain values of interventricular septum and right ventricular free wall were derived from the raw-dicom images. The analysis was performed using the dedicated software for the measurement of right ventricular strain. Results Total 65 patients were enrolled. The values of global left ventricular strain were increased after the follow up. There were no changes in global longitudinal strain of the right ventricle. But longitudinal stain values acquired from right ventricular free walls were decreased even the strain values measured at left ventricle and interventricular septum were improved. Conclusion Interventricular septal dysfunction due to ischemic injury can affect long term right ventricular dysfunction. This finding suggests the interventricular dependence between cardiac chambers and can provide the development of heart failure in myocardial infarction patient even after the successful revascularization. Strain values of both ventricles Left ventricle after revascularization (n = 65) 1 year later (n = 65) P values Global longitudinal strain (%) -12.84 ± 4.50 -15.62 ± 4.45 <0.001 Septal longitudinal strain (%) -10.77 ± 5.96 -14.02 ± 5.26 <0.001 Right ventricle Global longitudinal strain (%) -19.36 ± 4.57 -19.47 ± 4.83 0.872 Septal longitudinal strain (%) -14.82 ± 4.48 -16.43 ± 6.03 0.055 Free wall longitudinal strain (%) -20.23 ± 5.33 -17.82 ± 5.70 0.010 Abstract P1535 Figure. Right ventricular segmental strain

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INFLUENCE OF RIGHT VENTRICULAR LEAD IMPLANTATION SITE CHOICE ON PACING EFFICIENCY

International Medical Journal ◽

10.37436/2308-5274-2019-4-3 ◽

2020 ◽

pp. 13-17

Author(s):

Dmitrii Aleksandrovich Lopyn ◽

Stanislav Valerevich Rybchynskyi ◽

Dmitrii Evgenevich Volkov

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Longitudinal Strain ◽

Treatment Options ◽

Global Longitudinal Strain ◽

Optimal Method ◽

Cardiac Stimulation ◽

Ventricular Lead ◽

The Right ◽

Stimulation Of

Currently the electrophysiological treatment options have been considered to be the most effective for many patients with arrhythmogenic cardiomyopathies, as well as in those with arrhythmias on the background of heart failure. Currently, the dependence of efficiency of the pacemakers on the location of the electrodes has been proven. In order to study the effect of a myocardial dysynchrony on the effectiveness of pacing depending on the location of the right ventricular electrode, an investigation has been performed. This study comprised the patients with a complete atrioventricular block, preserved ejection fraction of the left ventricle (more than 50 %), with no history of myocardial infarction, who were implanted with the two−chamber pacemaker. It has been established that the best results were achieved with a stimulation of the middle and lower septal zone of the right ventricle, the worst ones were obtained with a stimulation of its apex. It has been found that the dynamics of the magnitude of segmental strains and a global longitudinal strain coincided with the dynamics of other parameters of the pacemaker effectiveness, which indicated the pathogenetic value of myocardial dysynchrony in the progression of heart failure after implantation of the pacemaker. Therefore it could be concluded that the studying of myocardial mobility by determining a longitudinal strain for assessing the functional state of the myocardium and the effectiveness of pacing is highly advisable. It is emphasized that the use of the latest strains−dependent techniques for cardiac performance evaluation in the patients with bradyarrhythmia have a great potential to predict the development of chronic heart failure and to choose the optimal method of physiological stimulation of the heart. Key words: right ventricular lead, cardiac stimulation, myocardial dyssynchrony.

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Subtle right ventricular dysfunction in asymptomatic chronic heavy cigarette smokers: a speckle tracking case-control study

The Egyptian Heart Journal ◽

10.1186/s43044-021-00151-y ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Mohammad Iqbal Janhangeer ◽

Ghada Youssef ◽

Weal El Naggar ◽

Dalia El Remisy

Keyword(s):

Cigarette Smoking ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Cigarette Consumption ◽

Cigarette Smokers ◽

The Right

Abstract Background Chronic heavy cigarette smoking can affect the right ventriclular function. The standard echocardiography may not show early right ventricular functional changes, and a more sensitive measure is needed. The aim of this work was to evaluate the subtle subclinical effects of chronic heavy cigarette smoking on the right ventricular function. The study included 55 healthy asymptomatic chronic heavy cigarette smokers (smoking history of at least 5 pack-years and a daily cigarette consumption of at least 1 pack) and 35 healthy non-smoking control subjects. Patients underwent a full clinical assessment and a conventional as well as a 2D-speckle tracking transthoracic echocardiography of the right ventricle and data was compared between the 2 groups. Results The mean age was 32.9 ± 7.2 years in smokers and 30.9 ± 7.9 years in non-smokers (p = 0.227). The 2 groups showed comparable conventional right ventricular systolic and diastolic functions. Smokers showed a significantly lower (less negative) right ventricular global longitudinal strain (− 19.0 ± 3.2% vs. − 24.5 ± 3.5%, p < 0.001). Patients with a higher daily cigarette consumption showed a poorer right ventricular global longitudinal strain (p = 0.014). Conclusion Chronic heavy cigarette smoking can adversely affect the right ventricular function, a finding that can be easily missed by conventional echocardiography and can be better detected by the right ventricular speckle tracking.

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Relationship between left atrial strain and left atrial bipolar voltage in patients undergoing catheter ablation for atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0387 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Takahashi ◽

T Kitai ◽

T Watanabe ◽

T Fujita

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Low Voltage ◽

Pulmonary Veins ◽

Global Longitudinal Strain ◽

Inferior Wall ◽

Bipolar Voltage ◽

Global Mean

Abstract Background Low-voltage zone (LVZ) in the left atrium (LA) seems to represent fibrosis. LA longitudinal strain assessed by speckle tracking method is known to correlate with the extent of fibrosis in patients with mitral valve disease. Purpose We sought to identify the relationship between LA longitudinal strain and LA bipolar voltage in patients with atrial fibrillation (AF). We tested the hypothesis that LA strain can predict LA bipolar voltage. Methods A total of 96 consecutive patients undergoing initial AF ablation were analyzed. All patients underwent transthoracic echocardiography including 2D speckle tracking measurement on the day before ablation during sinus rhythm (SR group, N=54) or during AF (AF group, N=42). LA longitudinal strain was measured at basal, mid, and roof level of septal, lateral, anterior, and inferior wall in apical 4- and 2-chamber view. Global longitudinal strain (GLS) was defined as an average value of the 12 segments. LA voltage map was created using EnSite system, and global mean voltage was defined as a mean of bipolar voltage of the whole LA excluding pulmonary veins and left atrial appendage. LVZ was defined as less than 1.0 mV. Results There was a significantly positive correlation between GLS and global mean voltage (r=0.708, p<0.001). Multivariate regression analysis showed that GLS and age were independent predictors of global mean voltage. There was a significant negative correlation between global mean voltage and LVZ areas. Conclusions There was a strong correlation between LA longitudinal strain and LA mean voltage. GLS can independently predict LA mean voltage, subsequently LVZ areas in patients with AF. Funding Acknowledgement Type of funding source: None

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Cardiac magnetic resonance derived global longitudinal strain outperfoms established functional parameters in prognostication after ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0234 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Holzknecht ◽

M Reindl ◽

C Tiller ◽

I Lechner ◽

T Hornung ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Prognostic Value ◽

Longitudinal Strain ◽

Independent Predictor ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

St Elevation

Abstract Background Left ventricular ejection fraction (LVEF) is the parameter of choice for left ventricular (LV) function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI); however, its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far. Purpose We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in the acute stage post-STEMI for the occurrence of major adverse cardiac events (MACE). Methods This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2–4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure. Results During a follow-up of 21 [IQR: 12–50] months, 40 (10%) patients experienced MACE. LVEF (p=0.005), MAPSE (p=0.001) and GLS (p<0.001) were significantly related to MACE. GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63–0.79; p<0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58–0.75; p=0.001) and LVEF (AUC: 0.64, 95% CI 0.54–0.73; p=0.005). After multivariable analysis, GLS emerged as sole independent predictor of MACE (HR: 1.22, 95% CI 1.11–1.35; p<0.001). Of note, GLS remained associated with MACE (p<0.001) even after adjustment for infarct size and microvascular obstruction. Conclusion CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage. Funding Acknowledgement Type of funding source: None

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