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. 2022 Apr 7:40:101028.
doi: 10.1016/j.ijcha.2022.101028. eCollection 2022 Jun.

Mechanical dispersion combined with global longitudinal strain estimated by three dimensional speckle tracking in patients with ST elevation myocardial infarction

Noriaki Iwahashi  1 , Jin Kirigaya  1 , Masaomi Gohbara  1 , Takeru Abe  2 , Mutsuo Horii  1 , Yohei Hanajima  1 , Noriko Toya  3 , Hironori Takahashi  1 , Hidekuni Kirigaya  1 , Yugo Minamimoto  1 , Yuichiro Kimura  1 , Kozo Okada  1 , Yasushi Matsuzawa  1 , Kiyoshi Hibi  1 , Masami Kosuge  1 , Toshiaki Ebina  1 , Kouichi Tamura  4 , Kazuo Kimura  1
Affiliations

Mechanical dispersion combined with global longitudinal strain estimated by three dimensional speckle tracking in patients with ST elevation myocardial infarction

Noriaki Iwahashi et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The role of left ventricular (LV) mechanical dispersion estimated after an ST elevation acute myocardial infarction (STEMI) remains unclear.

Methods: The study participants were 208 consecutive patients (152 men, age = 72 years) presenting with STEMI for the first time who underwent primary percutaneous coronary intervention (PCI) within 12 h of STEMI onset. Within 48 h of PCI (mean = 24 h), 2D and 3D speckle-tracking echocardiography were performed. The global longitudinal strain (GLS) was calculated using 3D (3D-GLS) and 2D (2D-GLS) speckle tracking. Mechanical dispersion was defined using the standard deviation (SD) of the time to regional peak longitudinal strain (LS) for all 16 segments for both 2D-STE and 3D-STE (2D-LS-SD, 3D-LS-SD). Infarct size was estimated by Tc99m-sestamibi as the total area of < 50% of the uptake area at 2 weeks. The patients were followed up for a longer period of time (median118months) and checked for major adverse cardiac events (MACE: cardiac death, heart failure).

Results: During follow-up, 55 patients experienced MACE. The cut-off values were determined using receiver operating characteristic curves. The multivariate analysis revealed that a 3D-LS-SD > 56.7 ms was a significant predictor of MACEs (hazard ratio = 1.991, 95% confidence interval 1.033-3.613, p = 0.03), but 2D-LS-SD > 58.1 ms was not an independent predictor of MACEs (hazard ratio = 1.577, 95% confidence interval 0.815-3.042, p = 0.1). Furthermore, the combination of 3D-GLS and 3D-LS-SD had accurate predictability for MACE, as shown by the Kaplan-Meier curves (log rank, χ2 = 94.1, p < 0.0001).

Conclusions: LV mechanical dispersion besides 3D-GLS assessed by 3D-STE immediately after PCI can predict long-term prognosis.

Keywords: 2D, two-dimensional; 3D, three-dimensional; AMI, acute myocardial infarction; CI, confidence interval; GLS, global longitudinal strain; HF, heart failure; IQR, interquartile range; LV, left ventricular; Mechanical dispersion; Prognosis; STEMI; STEMI, ST-segment elevation myocardial infarction; Speckle tracking; Three dimensional echocardiography.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Receiver operating characteristics curves for predicting MACE. Left, 3D-GLS and 2D-GLS; right. 3D-LS-SD and 2D—LS-SD. These figures show the calculation of receiver operating characteristic (ROC) curves to determine the appropriate cut-off values revealed values. 3D-GLS: AUC = 0.869 (0.796–0.918), p < 0.0001, The optimal cut-off point of 3D-GLS was −11.3 (1-specificity = 0.163, sensitivity = 0.627). 2D-GLS: AUC = 0.808 (0.728–0.868), p < 0.0001. The optimal cut-off point of 2D-GLS was −11.2 (1-specificity = 0.2909, sensitivity = 0.811) 3D-LS-SD: AUC = 0.710 (0.625–0.782), p < 0.0001. The optimal cut-off point of 3D-LS-SD was 56.7 (1-specificity = 0.272, sensitivity = 0.614) 2D-LS-SD: AUC = 0.655 (0.563–0.726), p < 0.0001. The optimal cut-off point of 2D-LS-SD was 58.1(1-specificity = 0.327, sensitivity = 0.607).
Fig. 2
Fig. 2
Kaplan-Meier survival curve analysis for MACE.Fig. 2A shows the significant difference between the patients with 3D-GLS < -11.3 and ≧-11.3(log rank, χ2 = 87.0, p < 0.0001). Fig. 2B shows the significant difference between the patients with 3D-LS-SD < 56.7 ms and ≧56.7 ms(log rank, χ2 = 21.9, p < 0.0001). Fig. 2C shows that of four groups; GroupA: 3D-GLS < -11.3 and 3D-LS-SD < 56.7 ms, GroupB: 3D-GLS≧-11.3 and 3D-LS-SD < 56.7 ms, GroupC: 3D-GLS < -11.3 and 3D-LS-SD≧56.7 ms, GroupD: GLS≧-11.3 and 3D-LS-SD≧56.7 ms. (log rank,χ2 = 94.1, p < 0.0001).
Fig. 3
Fig. 3
The plots of 3D-GLS and 3D-LS-SD. Four groups were determined based on the cut-off value determined by the cut-off values of the ROC curves. GroupA: 3D-GLS < -11.3 and 3D-LS-SD < 56.7 msec, GroupB: 3D-GLS≧-11.3 and 3D-LS-SD < 56.7 msec, GroupC: 3D-GLS < -11.3 and 3D-LS-SD≧56.7msec, GroupD: GLS≧-11.3 and 3D-LS-SD≧56.7 msec. The red plot indicates the patients with MACE and the blue plot indicates the patients without MACE. Significant differences among the four groups were observed (χ2 = 101.1, p < 0.0001).
Supplementary figure 1
Supplementary figure 1
Supplementary figure 2
Supplementary figure 2
Supplementary figure 3
Supplementary figure 3
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References

    1. Biering-Sørensen T., Shah S.J., Anand I., Sweitzer N., Claggett B., Liu L.i., Pitt B., Pfeffer M.A., Solomon S.D., Shah A.M. Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2017;19(8):1043–1052. - PMC - PubMed
    1. Shin S.-H., Hung C.-L., Uno H., Hassanein A.H., Verma A., Bourgoun M., Køber L., Ghali J.K., Velazquez E.J., Califf R.M., Pfeffer M.A., Solomon S.D. Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation. 2010;121(9):1096–1103. - PubMed
    1. Kosmidou I., Redfors B., Selker H.P., Thiele H., Patel M.R., Udelson J.E., et al. Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials. Eur. Heart J. 2017;38:1656–1663. - PubMed
    1. Hensen L.C.R., Goossens K., Podlesnikar T., Rotmans J.I., Jukema J.W., Delgado V., et al. Left Ventricular Mechanical Dispersion and Global Longitudinal Strain and Ventricular Arrhythmias in Predialysis and Dialysis Patients. J. Am. Soc. Echocardiog.: Official Publication Am. Soc. Echocardiog. 2018;31:777–783. - PubMed
    1. Sutton M.G.S.J., Sharpe N. Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation. 2000;101(25):2981–2988. - PubMed