Three-dimensional echocardiographic assessment of left ventricular geometric changes following acute myocardial infarction

Abstract

Acute ST-segment elevation myocardial infarction (STEMI) is associated with left ventricular (LV) structural and functional consequences. We aimed to elucidate LV geometric changes following STEMI using three-dimensional (3D) echocardiography (3DE) and to assess their functional implications using two-dimensional (2D) speckle tracking echocardiography (STE). The study included 71 patients with STEMI who underwent baseline and 6-month follow-up 2D- and 3DE. Measured parameters included LV dimensions, biplane volumes, wall motion assessment, 2D LV global longitudinal strain (GLS), and 3D LV volumes, sphericity index and systolic dyssynchrony index. According to 3DE, LV geometric changes were classified as, adverse remodeling, reverse remodeling, and minimal LV volumetric changes. The occurrence of in-hospital and follow-up major adverse cardiovascular events (MACE) was assessed among the study population. The incidence of developing adverse remodeling was 25.4% while that of reverse remodeling was 36.6%. Adverse remodeling patients had significantly higher in-hospital MACE. Reverse remodeling was associated with significantly improved GLS, that was less evident in those with minimal LV geometric changes, and non-significant improvement for adverse remodeling group. LV baseline 2D GLS significantly correlated with follow-up 3D volumes among both reverse and adverse remodeling groups. Female gender and higher absolute GLS change upon follow-up were significantly associated with reverse remodeling. ROC-derived cutoff for adverse remodeling reallocated a substantial number of patients from the minimal change group to the adverse remodeling. Following acute STEMI, two-dimensional GLS was associated with and potentially predictive of changes in LV volumes as detected by three-dimensional echocardiography.

Keywords: 3D echocardiography; Global longitudinal strain; Left ventricular remodeling; Myocardial infarction.

Fig. 1

Example of the three-dimensional full-volume and two-dimensional speckle tracking derived measures, respectively: (left); 3D-derived 4-chamber, 2-chamber, and short-axis images, (middle); 3D-derived LV time-volume curves and calculated global volumes, ejection fraction, sphericity and dyssynchrony indices, (right); 2D-speckle tracking bull`s eye display of LV segmental and GLS

Fig. 2

Left ventricular changes among different remodeling groups. a Global longitudinal strain, b Sphericity index, c End-diastolic volume, d End-systolic volume. Parameters were displayed at baseline and six-month follow-up with paired analysis within each group and one-way ANOVA between groups. 3D three-dimensional, Adverse R adverse remodeling, BL baseline, EDV end-diastolic volume, ESV end-systolic volume, EF ejection fraction, FU follow-up, GLS global longitudinal strain, Minimal Δ minimal change, Reverse R reverse remodeling, SI sphericity index. Within-group paired analysis of echocardiographic data at 6-month follow-up compared to that at baseline is indicated by p-value displayed above each two corresponding bars. One-way ANOVA comparing echocardiographic data between different LV remodeling groups is indicated as Baseline (BL) p-value and Follow-up (FU) p-value. Post-hoc Bonferroni analysis is indicated by the black arcs within the graph and their corresponding p-value. a GLS at baseline & follow-up, b Sphericity index at baseline & follow-up, c EDV at baseline & follow-up and d ESV at baseline & follow-up

Fig. 3

Correlation between baseline left ventricular global longitudinal strain and follow-up LV end-diastolic and end-systolic volumes among the Adverse remodeling group a and Reverse remodeling group b. AR adverse remodeling, EDV end-diastolic volume, ESV end-systolic volume, GLS global longitudinal strain, RR reverse remodeling, r (correlation coefficient) and p (significance of correlation). a Baseline LV GLS vs Follow-up volumes among the Adverse remodeling (AR) group and b Baseline LV GLS vs Follow-up volumes among the Reverse remodeling (RR) group

Fig. 4

Receiver-operating characteristic (ROC) analysis of the percentage change in 3D end-diastolic volume (Adverse remodeling) (left), the percentage change in in 3D end-systolic volume (Reverse remodeling) (middle), and the percentage of 2D global longitudinal strain at follow-up (right) for the cumulative MACE. AUC area under the curve, GLS global longitudinal strain, MACE major adverse cardiovascular events