Speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior ST elevation myocardial infarction in patients managed by primary percutaneous coronary intervention

Abstract

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. LV remodeling is an important factor in the pathophysiology of advancing heart failure (HF).

Aim of the work: To evaluate the value of speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior STEMI in patients managed by primary PCI.

Methodology: Eighty-five patients with first acute anterior STEMI underwent primary PCI. Patients were followed up for 6 months. Echocardiography was done within 48 h [1] Standard transthoracic 2D echocardiographic examination: LV internal dimensions and volumes, Left Ventricular EF, and Wall Motion Score Index: [2] LV peak systolic global longitudinal strain and Torsion dynamics were assessed. Echocardiography was repeated at 6 months LV volumes and EF were calculated. LV remodeling was defined as an increase in LV EDV ≥ 20% 6 months after infarction as compared to baseline data. Patients were then classified into Group I: did not develop LV remodeling. Group II: developed LV remodeling. Both groups were studied to determine predictors of LV remodeling.

Results: At baseline echocardiographic evaluation there was no statistically significant difference between both groups regarding both LVEDD and LVEDV, while there was statistically significant increase in both LV ESD and LV ESV, with statistically significant lower Ejection Fraction, in LV remodeling group. There was also statistically significant higher LV peak systolic GLS values in LV remodeling group, the best cut-off value was >-12.5 (Sensitivity 87%, Specificity 85%) and LV torsion was also statistically significantly lower in the LV remodeling group, with the best cut-off value for LV torsion was <9.5°, [Sensitivity 91%, Specificity 85%].Independent predictors of LV remodeling after AMI: baseline WMSI > 1.8, baseline LV EF < 40, GLS > -12.5%, LV torsion < 9.5°, CK-MB > 500 U/L, baseline Thrombus grade > 4 and total ischemic time.

Conclusion: Average peak systolic GLS and LV torsion at echocardiography done early after myocardial infarction are independent predictors of LV remodeling after anterior STEMI and can be used to predict occurrence of LV remodeling after 6 months.

Keywords: Left ventricular remodeling; Remodeling; Speckle tracking.

Fig. 1

ROC curve showing the Best Cut-off value of WMSI for detection of remodeling is 1.8 with sensitivity 90%, specificity 88%, positive predictive value 89%, negative predictive value 94%.

Fig. 2

Best cut-off point for average LV peak systolic GLS was >−12.5, sensitivity 87%, specificity 85%, positive predictive value 83% and negative predictive value 88%.

Fig. 3

Best cut-off value for LV torsion was <9.5°, sensitivity 91%, specificity 85%, positive predictive value 89% and negative predictive value 95%.

Fig. 4

Correlation between LV torsion and average peak LV GLS [r = −0.659, P = 0.000].

Fig. 5

[A] GLS in a patient from LV non-remodeling group in the apical long axis view showing GLS −11.9% in long axis view. [B] GLS in a patient from LV non-remodeling group in the apical 4 chamber view showing GLS −13.1% in 4 chamber view. [C] GLS in a patient from LV non-remodeling group in the apical 2 chamber view showing GLS −15.8% in 2 chamber view. [D] Bull’s eye view showing peak systolic GLS −14.4% in a patient from the LV non-remodeling group.

Fig. 6

LV torsion in a patient from LV non remodeling group 21.48 degree.

Fig. 7

[A] GLS in a patient from LV remodeling group in the apical long axis view showing GLS −5.8% in long axis view. [B] GLS in a patient from LV remodeling group in the apical 4 chamber view showing GLS −12.2% in 4 chamber view. [C] GLS in a patient from LV remodeling group in the apical 2 chamber view showing GLS −13.4% in 2 chamber view. [D] Bull’s eye view showing peak systolic GLS −10.2% in a patient from the LV remodeling group.

Fig. 8

LV torsion in a patient from LV remodeling group 8.77 degree.