Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction

• Background. Opening of an occluded infarct related artery reduces infarct size and improves survival in acute ST-elevation myocardial infarction (STEMI). In this study we performed tissue Doppler analysis (peak strain, displacement, mitral annular movement (MAM)) and compared with visual assessment for the study of the correlation of measurements of global, regional and segmental function with final infarct size and transmurality. In addition, myocardial risk area was determined and a prediction sought for the development of infarct transmurality 50%.Methods. Twenty six patients with STEMI submitted for primary percutaneous coronary intervention (PCI) were examined with echocardiography on the catheterization table. Four to eight weeks later repeat echocardiography was performed for reassessment of function and magnetic resonance imaging for the determination of final infarct size and transmurality.Results. On a global level, wall motion score index (WMSI), ejection fraction (EF), strain, and displacement all showed significant differences (p ≤ 0.001, p ≤ 0.001, p ≤ 0.001 and p = 0.03) between the two study visits, but MAM did not (p = 0.17). On all levels (global, regional and segmental) and both pre- and post PCI, WMSI showed a higher correlation with scar transmurality compared to strain. We found that both strain and WMSI predicted the development of scar transmurality 50%, but strain added no significant information to that obtained with WMSI in a logistic regression analysis.Conclusions. In patients with acute STEMI, WMSI, EF, strain, and displacement showed significant changes between the pre- and post PCI exam. In a ROC-analysis, strain had 64% sensitivity at 80% specificity and WMSI around 90% sensitivity at 80% specificity for the detection of scar with transmurality 50% at follow-up. 

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

gadolinium pentetate

acute heart infarction

adult

aged

apparatus

article

clinical article

diagnostic imaging

diagnostic value

echocardiography

female

heart ejection fraction

heart infarction size

heart ventricle wall motion

human

image analysis

image enhancement

male

measurement

nuclear magnetic resonance imaging

scar

scoring system

sensitivity and specificity

tissue Doppler imaging

wall motion score index

clinical trial

convalescence

Doppler echocardiography

echography

follow up

heart infarction

heart stroke volume

hospitalization

methodology

middle aged

observer variation

prediction and forecasting

receiver operating characteristic

reproducibility

risk factor

standard

statistics

transluminal coronary angioplasty

validation study

Angioplasty

Transluminal

Percutaneous Coronary

Echocardiography

Doppler

Follow-Up Studies

Humans

Magnetic Resonance Imaging

Myocardial Infarction

Predictive Value of Tests

Recovery of Function

Reproducibility of Results

Risk Factors

ROC Curve

Severity of Illness Index

Stroke Volume

MEDICINE

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)