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Temporal deformation pattern in acute and late phases of ST-elevation myocardial infarction: incremental value of longitudinal post-systolic strain to assess myocardial viability

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Abstract

Background

Identification of transmural extent and degree of non-viability after ST-segment elevation myocardial infarction (STEMI) is clinically important. The objective of the present study was to assess the regional mechanics and temporal deformation patterns using speckle tracking echocardiography (STE) in acute and later phases of STEMI to predict myocardial damage in these patients.

Methods and results

Ninety-eight patients with first STEMI underwent both echocardiography and cardiac magnetic resonance imaging in acute phase and at 6 months follow-up with 2D STE-derived measurements of peak longitudinal strain (PLS), Pre-STretch index (PST) and post-systolic deformation index (PSI). For each segment, late gadolinium enhancement (LGE) was defined as transmural (LGE >66 %) or non-transmural (<66 %). Global deformation values were significantly correlated with LVEFCMR and infarct size at both visits. A significantly lower value of segmental PLS and higher PSI and PST in necrotic segments were observed comparatively to control, adjacent and remote segments. The best parameters to predict transmural extent in acute phase were PSI with a cutoff value of 8 % (AUC: 0.84) and PLS with a cutoff value of −13 % (AUC: 0.86). PST showed high specificity, but poor sensitivity in predicting transmural extent. More importantly, the addition of PSI and PST to PLS in acute phase was associated with improved prediction of viability at 6 months (integrated discrimination improvement 2.5 % p < 0.01; net reclassification improvement 27 %; p < 0.01).

Conclusions

All systolic deformation values separated transmural from non-transmural scarring. PLS combined with additional information relative to post-systolic deformation appears to be the most informative parameters to predict the transmural extent of MI in the early and late phases of MI.

Clinical trial registration

http://clinicaltrials.gov/show/NCT01109225; NCT01109225.

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Acknowledgments

The study was supported by a grant from the French Ministry of Health (Programme de Recherche Clinique Inter-régional 2009) and sponsored by the CHU Nancy, Nancy, France.

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    Authors and Affiliations

    1. Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, 54511, Vandoeuvre les Nancy, France

      Olivier Huttin, Maxime Benichou, Simon Lemoine, Yves Juillière, Nicolas Sadoul & Christine Selton-Suty

    2. Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France

      Pierre-Yves Marie

    3. Centre d’Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France

      Damien Mandry, Emilien Micard & Marine Beaumont

    4. INSERM Centre d’Investigation Clinique CIC-P 9501, Institut Lorrain du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France

      Erwan Bozec, Kevin Duarte, Patrick Rossignol & Nicolas Girerd

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    1. Olivier Huttin
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    Correspondence to Olivier Huttin.

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    N. Girerd and C. Selton-Suty contributed equally to this manuscript.

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    Huttin, O., Marie, PY., Benichou, M. et al. Temporal deformation pattern in acute and late phases of ST-elevation myocardial infarction: incremental value of longitudinal post-systolic strain to assess myocardial viability. Clin Res Cardiol 105, 815–826 (2016). https://doi.org/10.1007/s00392-016-0989-6

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    • DOI: https://doi.org/10.1007/s00392-016-0989-6

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