e-Article
Oral Abstract session * Role of imaging to predict left ventricular remodeling after acute myocardial infarction: 12/12/2013, 16:30-18:00 * Location: Bursa
Document Type
Article
Author
Dandrea, A; Riegler, L; Di Palma, E; Martone, F; Cocchie, R; Padalino, R; Calabro, R; Caso, PIO; Russo, MG; Bossone, E; Buera Surribas, I; Mutuberria Urdaniz, M; Rodriguez Palomares, JF; Pineda Sanchez, V; Otaegui Irurueta, I; Gutierrez Garcia-Moreno, L; Evangelista Masip, A; Garcia Dorado, D; Hristova, K; Katova, TZ; Kostova, V; Simova, I; Okino, S; Sugioka, J; Ikeda, A; Maekawa, J; Maekawa, S; Ichikawa, S; Kuroiwa, N; Okamoto, S; Fukuzawa, S; Inagaki, M; Spinelli, L; Morisco, C; Giudice, K; Castaldo, D; Trimarco, B
Source
European Journal of Echocardiography; December 2013, Vol. 14 Issue: Supplement 2 pii55-ii55, 1p
Subject
Language
ISSN
15252167; 15322114
Abstract
Aims: To test whether X-Strain 4D analysis could predict left ventricular (LV) remodeling in patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). Methods: In 75 patients (61.7±8.5 years) with recent NSTEMI (between 72 hours and 14 days), undergoing coronary angiography for recurrent angina, myocardial deformation parameters were measured before and 24 hours after reperfusion therapy. Echocardiography was performed using a commercial US system (MyLabAlpha, Esaote Florence, Italy); digitized 2D video clips on 4, 3- 2 chambers apical views were analyzed offline by a specifically designed tissue tracking software (XStrain™, Esaote, Florence, Italy), for the semiautomatic quantification of LV volumes, ejection fraction and strain. Strain in all LV segments was averaged to obtain a global value (Global longitudinal Strain – GLS). Infarct size was estimated by clinical parameters and cardiac markers. After 6 months from intervention, LV negative remodeling was defined as lack of improvement of LV function, with increase in LV end-diastolic volume of greater than or equal than 15%. Results: At follow-up, patients were subdivided into remodeled (n = 32) and non-remodeled (n = 43) groups. Patients with negative LV remodeling had significantly lower baseline LV ejection fraction (43.5±6.7 vs. 48.6 ±5.3 %; p<0.01), higher peak troponin I (p<0.001) and reduced GLS (- 10.6 ± 5.7 vs - 16.4 ± 6.1 % p<0.001) than those without LV remodeling. GLS showed a close correlation with peak troponin I after PCI (r = 0.65, P<0.0001) and LV WMSI (r = 0.45, p<0.001). By multivariable analysis, peak of Troponin I after PCI (P < 0.005), GLS at baseline (OR: 4.5; p<0.0001), and lack of improvement of GLS soon after PCI (OR: 1.33, P <0.01) were powerful independent predictors of negative LV remodelling at follow-up. In particular, a GLS < 12 % showed a sensitivity and a specificity respectively of 78.7% and 87.5% to predict negative LV remodelling at follow-up. Conclusions: in patients with recent NSTEMI, longitudinal myocardial deformation assessed by X-Strain 4D analysis is a powerful independent predictor of LV remodeling after reperfusion therapy.