Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Jan;30(1):600-608.
doi: 10.1007/s00330-019-06338-x. Epub 2019 Jul 26.

Recovery and prognostic value of myocardial strain in ST-segment elevation myocardial infarction patients with a concurrent chronic total occlusion

Joëlle Elias  1 , Ivo M van Dongen  2 , Loes P Hoebers  2 , Dagmar M Ouweneel  2 , Bimmer E P M Claessen  2 , Truls Råmunddal  3 , Peep Laanmets  4 , Erlend Eriksen  5 , Jan J Piek  2 , René J van der Schaaf  6 , Dan Ioanes  3 , Robin Nijveldt  7 , Jan G Tijssen  2 , José P S Henriques  2 , Alexander Hirsch  8 ; EXPLORE investigators
Affiliations
Randomized Controlled Trial

Recovery and prognostic value of myocardial strain in ST-segment elevation myocardial infarction patients with a concurrent chronic total occlusion

Joëlle Elias et al. Eur Radiol. 2020 Jan.

Abstract

Objectives: Global left ventricular (LV) function is routinely used to assess cardiac function; however, myocardial strain is able to identify more subtle dysfunction. We aimed to determine the recovery and prognostic value of featuring tracking (FT) cardiovascular magnetic resonance (CMR) strain in ST-segment elevation myocardial infarction (STEMI) patients with a concurrent chronic total occlusion (CTO).

Methods: In the randomized EXPLORE trial, there was no significant difference in global LV function after percutaneous coronary intervention (PCI) of the CTO, compared with no-CTO PCI, post-STEMI. In the current study, we included 200 of the 302 EXPLORE patients with a baseline CMR, of which 180 also had 4-month follow-up (serial) CMR. Global longitudinal strain (GLS) was calculated from 3 long-axis views. Global circumferential strain (GCS) and segmental strain were calculated from 3 short-axis views (basal, mid, and apical).

Results: Global strain significantly improved at 4 months (GLS ∆ - 1.8 ± 4.3%, p < 0.001; GCS ∆ - 1.7 ± 4.7%, p < 0.001); however, there was no treatment effect of CTO-PCI on strain recovery. GLS was a significant predictor for 4 months of LV ejection fraction (p = 0.006), incremental to other CMR parameters including infarct size. For mortality, infarct size remained the strongest predictor. On regional level, segmental strain independently predicted recovery in the dysfunctional segments (p < 0.001).

Conclusions: Global and segmental myocardial strains significantly improved over time, with no effect of CTO-PCI. Global strain was associated with outcome and segmental strain was an independent predictor for regional LV recovery in the dysfunctional CTO territory. Further research is needed to determine the additional prognostic value of strain beyond routine CMR parameters.

Key points: • In STEMI patients with a concurrent CTO, strain significantly improves over time, regardless of CTO-PCI. • Global strain is an independent predictor for functional recovery, incremental to infarct size, LVEF, and clinical parameters. • Segmental strain was able to predict the recovery of wall thickening, incremental to transmural extent of infarction.

Keywords: Coronary occlusion; Magnetic resonance imaging; Percutaneous coronary intervention; ST elevation myocardial infarction.

PubMed Disclaimer

Conflict of interest statement

JPSH has received grants from Abbott Vascular during the conduct of the study and has received grants from B. Braun, Abiomed, and Biotronik outside the submitted work. RJvdS has received grants from Abbott Vascular, Biotronik, and Biosensors, has received personal fees from Biotronik and Boston Scientific, has been a consultant for Biotronik, and has received speaker fees from OrbusNeich, Boston Scientific, and Asahi Intecc outside the submitted work. TR has been a proctor for Boston Scientific.

Figures

Fig. 1
Fig. 1
Flowchart of the EXPLORE trial and available cardiovascular magnetic resonance data. CTO = chronic total occlusion; PCI = percutaneous coronary intervention; CMR = cardiac magnetic resonance; GLS = global longitudinal strain; GCS = global circumferential strain
Fig. 2
Fig. 2
Recovery of global strain in the total cardiovascular magnetic resonance population from baseline to follow-up. Global longitudinal strain (GLS) (left) and global circumferential strain (GCS) (right) from baseline to 4-month follow-up. Whiskers indicate standard deviation
Fig. 3
Fig. 3
Kaplan-Meier curves representing long-term mortality in patients with GCS < − 14% and patients with GCS > − 14%. Kaplan-Meier estimates of the cumulative event rates
See this image and copyright information in PMC

References

    1. Bodi V, Sanchis J, Nunez J, et al. Prognostic value of a comprehensive cardiac magnetic resonance assessment soon after a first ST-segment elevation myocardial infarction. JACC Cardiovasc Imaging. 2009;2(7):835–842. doi: 10.1016/j.jcmg.2009.03.011. - DOI - PubMed
    1. Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S. Cardiovascular magnetic resonance myocardial feature tracking: concepts and clinical applications. Circ Cardiovasc Imaging. 2016;9(4):e004077. doi: 10.1161/CIRCIMAGING.115.004077. - DOI - PubMed
    1. Khan JN, Singh A, Nazir SA, Kanagala P, Gershlick AH, McCann GP. Comparison of cardiovascular magnetic resonance feature tracking and tagging for the assessment of left ventricular systolic strain in acute myocardial infarction. Eur J Radiol. 2015;84(5):840–848. doi: 10.1016/j.ejrad.2015.02.002. - DOI - PubMed
    1. Hor KN, Gottliebson WM, Carson C, et al. Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. JACC Cardiovasc Imaging. 2010;3(2):144–151. doi: 10.1016/j.jcmg.2009.11.006. - DOI - PubMed
    1. Shetye AM, Nazir SA, Razvi NA, et al. Comparison of global myocardial strain assessed by cardiovascular magnetic resonance tagging and feature tracking to infarct size at predicting remodelling following STEMI. BMC Cardiovasc Disord. 2017;17(1):7. doi: 10.1186/s12872-016-0461-6. - DOI - PMC - PubMed

Publication types

MeSH terms