Longitudinal and Circumferential Strain Rate, Left Ventricular Remodeling, and Prognosis After Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 56; no. 22; pp. 1812 - 1822
• Main Authors: Hung, Chung-Lieh, MD, Verma, Anil, MD, Uno, Hajime, PhD, Shin, Sung-Hee, MD, Bourgoun, Mikhail, MD, Hassanein, Amira H., MD, McMurray, John J., MD, Velazquez, Eric J., MD, Kober, Lars, MD, Pfeffer, Marc A., MD, PhD, Solomon, Scott D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 23.11.2010; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Biological and medical sciences; Biomechanical Phenomena; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Coronary heart disease; Female; Heart; Heart attacks; heart failure; Humans; Internal Medicine; Male; Medical sciences; Middle Aged; Mortality; myocardial infarction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Prognosis; remodeling; speckle-tracking imaging; Ultrasonography; Ventricular Remodeling; strain rate; remodeling; ejection fraction; WMSI; systolic strain rate; myocardial infarction; LV; AUC; 2-dimensional; area under curve; 2D; S; left ventricle/ventricular; MI; SR; strain; heart failure; EF; CI; ESV; end-systolic volume; left atrial; wall motion score index; speckle-tracking imaging; LA; SRs; mortality; confidence interval; HF; Myocardial infarction; Vascular remodeling; Prognosis; Rate; Cardiovascular disease; Circulatory system; Cardiology; Coronary heart disease; Myocardial disease; Left ventricle; Strain
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.06.044

Objectives We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI). Background Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions. Methods The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes. Results Both longitudinal (mean: −5.1 ± 1.6 100/ms) and circumferential SRs (mean: −8.0 ± 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001). Conclusions Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI.