THE COMBINATION OF DYSSYNCHRONY AND GLOBAL LONGITUDINAL STRAIN BY 3D SPECKLE TRACKING AFTER ST-ELEVATION MYOCARDIAL INFARCTION IS USEFUL FOR PREDICTION OF FINAL INFARCT SIZE AND LEFT VENTRICULAR REMODELING

Background: Left ventricular (LV) global strain estimated immediately after ST elevation AMI (STEMI) was reported as a predictor of LV remodeling. Furthermore, LV dyssynchrony estimated by 2D strain is also a prognosticator. However, strain analysis ideally should be assessed by 3D speckle tracking, in order to avoid through plane motion. We explored the usefulness of these two variable assessed by 3D speckle tracking in patients with a first STEMI. Methods: Consecutive 190 patients (131 men, age 65 years, peak CPK=3169 IU/l) presenting with a first STEMI who underwent primary PCI within 12 hours of onset were enrolled. Within 24 h of PCI, echocardiography was performed by iE33(Philips). 3D speckle tracking was analyzed by 4D LV-Analysis (TOM-TEC, Germany). Global longitudinal strain was calculated (3D-GLS) and the standard deviation (SD) of time to regional peak 3D longitudinal strain (3D-Long-SD) for all 16 segments was assessed as the parameter of dyssynchrony. Final infarct size was defined using Tc99m-sestamibi as the total area of <50%uptake area at 2 weeks. Echocardiography was repeated 12 months later and LV remodeling was defined as an absolute increase in LVEDV of more than 20%. Results: LV remodeling was observed in 52 patients at 12 months. Both 3D-GLS and 3D-Long-SD had significant relationships with infarct size (r2=0.236, 0.169, p<0.0001). Furthermore, both of the worst tertile of them predicted LV remodeling (Odds ratio = 2.634, 95%CI; 1.322-5.308, p<0.001) (Odds ratio = 3.846, 95%CI;1.887-8.011, p<0.001). Table shows logistic regression analysis for LV remodeling and the combination of these indexes was the strongest predictor (Odds ratio = 2.58, 95%CI 1.003-6.723, p=0.04). Conclusions: In patients with a first STEMI, GLS and LV dyssynchrony assessed by 3D speckle tracking echocardiography immediately after PCI can predict final infarct size and LV remodeling. The combination of these parameters was especially useful to predict LV remodeling.

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Abstract 12576: Impact of Insulin Resistance on Left Ventricular Remodeling in Patients With a First-Time ST Elevation Acute Myocardial Infarction Without Overt Diabetes Mellitus

Circulation ◽

10.1161/circ.130.suppl_2.12576 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Noriaki Iwahashi ◽

Masaomi Gohbara ◽

shunsuke Kataoka ◽

Eiichi Akiyama ◽

Nobuhiko Maejima ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Insulin Resistance ◽

Longitudinal Strain ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

St Elevation ◽

First Time

Backgrounds: Insulin resistance (IR) has been reported to be associated with worse prognosis in patients with coronary artery disease. However, the role of IR in patients with acute myocardial infarction(AMI) remains unclear. Therefore, we explored the impact of IR on left ventricular remodeling (LVR) after ST elevation AMI (STEMI) without overt DM. Methods: One hundred seventy patients with a first-time ST elevation AMI (STEMI) who underwent reperfusion within 12 hours were enrolled in this study. Patients had no history of diabetes mellitus prior to their first STEMI. We examined echocardiography results 24 hours after PCI and 12 months later. We measured global longitudinal strain using 3D speckle tracking echocardiography (4D LV Analysis, TOMTEC, Germany). We calculated 3D global longitudinal strain(3D-GLS) as the parameter of accurate systolic function free from tethering effect. Infarct size was defined using Tc99m-sestamibi as the area of <50% uptake at 2 weeks. We checked HOMA-R at 2 weeks. The absolute difference of the LV end-diastolic volume (ΔLVEDV) after 12 months was calculated as a parameter of LVR. We excluded the patients with CKD (eGFR <30ml/min/1.73m2) and the high fasting glucose level (>140mg/dl). Results: Infarct size (r2=0.30, p=0.03) and HOMA-R (r2=0.50, p=0.018) had a good association with ΔLVEDV. There was a significant relationship between HOMA-R andΔLVEDV (r2=0.096, p=0.0007). Multiple regression analysis showed that HOMA-R was the strongest predictor of ΔLVEDV, followed by 3D-GLS (Table). Conclusions: Insulin resistance was the strongest predictor for the degree of LV remodeling in patients with a first STEM without overt DM.

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