Assessment of left ventricular function in ST-elevation myocardial infarction by global longitudinal strain: a comparison with ejection fraction, infarct size, and wall motion score index measured by non-invasive imaging modalities

OBJECTIVETo assess the relations between early filling deceleration time, left ventricular remodelling, and cardiac mortality in an unselected group of postinfarction patients.DESIGN AND PATIENTSProspective evaluation of 131 consecutive patients with first acute myocardial infarction. Echocardiography was performed on day 1, day 2, day 3, day 7, at three and six weeks, and at three, six, and 12 months after infarction. According to deceleration time on day 1, patients were divided into groups with short (< 150 ms) and normal deceleration time (⩾ 150 ms).SETTINGTertiary care centre.RESULTSPatients with a short deceleration time had higher end systolic and end diastolic volume indices and a higher wall motion score index, but a lower ejection fraction, in the year after infarction. These patients also showed a significant increase in end diastolic (p < 0.001) and end systolic volume indices (p = 0.007) during the follow up period, while ejection fraction and wall motion score index remained unchanged. In the group with normal deceleration time, end diastolic volume index increased (p < 0.001) but end systolic volume index did not change; in addition, the ejection fraction increased (p = 0.002) and the wall motion score index decreased (p < 0.001). One year and five year survival analysis showed greater cardiac mortality in patients with a short deceleration time (p = 0.04 and p = 0.02, respectively). In a Cox model, which included initial ejection fraction, infarct location, and infarct size, deceleration time on day 1 was the only significant predictor of five year mortality.CONCLUSIONSA short deceleration time on day 1 after acute myocardial infarction can identify patients who are likely to undergo left ventricular remodelling in the following year. These patients have a higher one year and five year cardiac mortality.

Download Full-text

Effect of Ischaemic Postconditioning on Recovery of Left Ventricular Contractile Function after Acute Myocardial Infarction

Journal of International Medical Research ◽

10.1177/147323001204000327 ◽

2012 ◽

Vol 40 (3) ◽

pp. 1082-1088 ◽

Cited By ~ 19

Author(s):

Cm Zhao ◽

Xj Yang ◽

Jh Yang ◽

Xj Cheng ◽

X Zhao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ejection Fraction ◽

Wall Motion ◽

Contractile Function ◽

Left Ventricular ◽

Control Group ◽

Wall Motion Score Index ◽

Lv Ejection Fraction ◽

Score Index

OBJECTIVE: This study investigated whether ischaemic postconditioning can improve recovery of myocardial contractile function in acute myocardial infarction patients 1 week and 6 months after angioplasty. METHODS: A total of 62 patients undergoing direct percutaneous coronary intervention after acute myocardial infarction were randomly assigned to receive four episodes of inflation and deflation of the angioplasty balloon in the early reperfusion period (postconditioned group, n = 32), or no additional intervention (control group, n = 30). Two-dimensional size and left ventricular (LV) global and regional contractile functions were then evaluated by echocardiography at 1 week and 6 months after angioplasty. RESULTS: At 1 week, there were no significant differences in left atrial diameter, LV end-diastolic diameter, LV end-diastolic volume, cardiac output, LV ejection fraction or wall motion score index between the two groups. At 6 months, LV ejection fraction was significantly increased and the wall motion score index significantly reduced in the postconditioned group compared with the control group. CONCLUSION: Ischaemic postconditioning can improve long-term LV contractile function 6 months after reperfusion following acute myocardial infarction.

Download Full-text

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

Download Full-text

The influence of afterload on left ventricular contractility: 2D-strain and dyssynchrony in stress echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.192 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Karev ◽

S Verbilo ◽

E Malev ◽

M Prokudina ◽

A Suvorov

Keyword(s):

Coronary Artery ◽

Left Ventricle ◽

Ejection Fraction ◽

Stress Echocardiography ◽

Longitudinal Strain ◽

Wall Motion ◽

Wall Motion Score Index ◽

Wall Motion Abnormalities ◽

Response To Exercise ◽

Score Index

Abstract Funding Acknowledgements Type of funding sources: None. Background Hypertensive response to exercise (HRE) has negative prognostic value but its impact on the left ventricle (LV) contractility and on stress echocardiography (SE) results remains controversial. The global longitudinal strain (GLS) and LV dyssynchrony changes in response to afterload increase were shown even in patients with narrow QRS at rest, but not on exertion. Purpose We aimed to analyze the relation between the blood pressure (BP) during SE and LV GLS and dyssynchrony changes. Methods We performed exercise SE on treadmill in 96 patients without coronary artery stenosis (invasive or CT coronary angiography). Patients divided into two groups: HRE (n = 41) and normal response to exercise (NRE) (n = 55). We analyzed GLS and standard deviation of time between the onset of QRS and segmental longitudinal strain peaks (STE-TIME SD) using speckle tracking and 3d-ejection fraction (EF) at rest and on exertion. Results 2D-EF increase was higher in patients with NRE, but 3D-EF did not differ between groups. Wall motion abnormalities (WMA) on peak stress were detected more often in patients with HRE who had higher wall motion score index (WMSI). GLS on exertion and its increment were lower in HRE group (Fig. 1 - "Bull’s eye" diagrams of GLS at rest and on exertion in patient with NRE (upper panel) and HRE (lower panel)). Among dyssynchrony markers we revealed higher values of STE-TIME SD on exertion in HRE group (Table 1). Moreover the analysis showed positive correlations between BP level on exertion and peak GLS (r = 0.56, p < 0.0001), GLS increase (r = 0.54, p < 0.0001) and STE-TIME SD on exertion (r = 0.27, p < 0.02) Conclusions HRE is associated with less increment in GLS and 2D-EF on exertion. Besides LV dyssynchrony signs can appear in response to exaggerated afterload increase even in patients with narrow QRS complexes. Patients with HRE more often show stress-induced WMA and have greater WMSI on exertion in absence of coronary artery lesions, thus HRE can alter the specificity of the test in transient ischemia detection. Table 1 HRE NRE p Δ-2D ejection fraction 5.0 (4.0; 7.0) 10.0 (8.0; 12.5) <0.0000001 Δ-3D ejection fraction 8.25 (4.0; 8.25) 8.24 (8.15; 11.65) 0.09 Wall motion abnormalities on exertion 46.34% 1.8% <0.00001 Wall motion score index 1.0 (1.0; 1.18) 1.0 (1.0; 1.0) 0.00013 GLS on exertion -21.0 (-22.0; -19.0) -24.0 (-26.5; -23.0) <0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) <0.0000001 STE-TIME SD-IMPOST 42.0 (35.0; 53.0) 35.0 (27.5; 45.0) 0.012 Left ventricle systolic function and dyssynchrony in two groups. Abstract Figure 1.

Download Full-text

Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction

American Heart Journal ◽

10.1016/j.ahj.2005.03.042 ◽

2006 ◽

Vol 151 (2) ◽

pp. 419-425 ◽

Cited By ~ 138

Author(s):

Jacob E. Møller ◽

Graham S. Hillis ◽

Jae K. Oh ◽

Guy S. Reeder ◽

Bernard J. Gersh ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ejection Fraction ◽

Risk Stratification ◽

Wall Motion ◽

Wall Motion Score Index ◽

Score Index

Download Full-text

Myocardial work in Stage 1 and 2 hypertensive patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab043 ◽

2021 ◽

Author(s):

Akshar Jaglan ◽

Sarah Roemer ◽

Ana Cristina Perez Moreno ◽

Bijoy K Khandheria

Keyword(s):

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Hypertensive Patients ◽

Non Invasive ◽

Significant Difference ◽

Lv Ejection Fraction ◽

Global Work ◽

Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P < 0.001), and GWW (P < 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

Download Full-text

Abstract 16032: Determinants of Exercise Capacity Assessed Using Combined Stress Echocardiography and Cardiopulmonary Exercise Testing in Patients Treated for Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.16032 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Krzysztof Smarz ◽

Tomasz Jaxa-Chamiec ◽

Beata Zaborska ◽

Maciej Tysarowski ◽

Andrzej Budaj

Keyword(s):

Myocardial Infarction ◽

Stress Echocardiography ◽

Wall Motion ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Combined Stress ◽

Wall Motion Score Index ◽

Cardiopulmonary Exercise ◽

Oxygen Difference ◽

Score Index

Introduction: Exercise capacity (EC) after acute myocardial infarction (AMI) influences prognosis, but the causes of its reduction are complex and not sufficiently studied. Methods: We prospectively enrolled consecutive patients who underwent percutaneous coronary intervention for their first AMI without residual coronary stenosis and with left ventricular ejection fraction (LVEF) > 40% more than 4 weeks after the AMI. We performed combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) using a semi-supine cycle ergometer to determine predictors of EC (peak oxygen uptake [VO 2 ]). Results: Among 81 patients (70% male, mean age 58 ± 11 years), 40% suffered AMI with ST-segment elevation (STEMI), and 60% non-STEMI, LVEF was 57 ± 7%; wall motion score index, 1.18 (IQR 1.06 - 1.31); peak VO 2 , 19.5 ± 5.4 mL/kg/min. Multivariate analysis ( Table ) revealed that parameters at peak exercise: heart rate (β = 0.17, p < 0.001), stroke volume (β = 0.09, p < 0.001), and arteriovenous oxygen difference (β = 93.51, p < 0.001) were independently positively correlated with peak VO 2 , with arteriovenous oxygen difference being its strongest contributor. At rest, left ventricular systolic and diastolic function parameters and the extent of myocardial scarring (wall motion score index) did not predict EC (p > 0.05). Conclusions: In patients treated for AMI with normal/mildly reduced LVEF, EC is associated with peak peripheral oxygen extraction as well as peak heart rate and peak stroke volume. CPET-SE is a useful tool to evaluate decreased fitness in this group.

Download Full-text