Mechanical dispersion combined with global longitudinal strain estimated by three dimensional speckle tracking in patients with ST elevation myocardial infarction

Noriaki Iwahashi; Jin Kirigaya; Masaomi Gohbara; Takeru Abe; Mutsuo Horii; Yohei Hanajima; Noriko Toya; Hironori Takahashi; Hidekuni Kirigaya; Yugo Minamimoto; Yuichiro Kimura; Kozo Okada; Yasushi Matsuzawa; Kiyoshi Hibi; Masami Kosuge; Toshiaki Ebina; Kouichi Tamura; Kazuo Kimura

doi:10.1016/j.ijcha.2022.101028

Mechanical dispersion combined with global longitudinal strain estimated by three dimensional speckle tracking in patients with ST elevation myocardial infarction

Int J Cardiol Heart Vasc. 2022 Apr 7:40:101028. doi: 10.1016/j.ijcha.2022.101028. eCollection 2022 Jun.

Authors

Noriaki Iwahashi¹, Jin Kirigaya¹, Masaomi Gohbara¹, Takeru Abe², Mutsuo Horii¹, Yohei Hanajima¹, Noriko Toya³, Hironori Takahashi¹, Hidekuni Kirigaya¹, Yugo Minamimoto¹, Yuichiro Kimura¹, Kozo Okada¹, Yasushi Matsuzawa¹, Kiyoshi Hibi¹, Masami Kosuge¹, Toshiaki Ebina¹, Kouichi Tamura⁴, Kazuo Kimura¹

Affiliations

¹ Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
² Department of Emergency Medicine, Yokohama City University Medical Center, Yokohama, Japan.
³ Department of Radiology, Yokohama City University Medical Center, Yokohama, Japan.
⁴ Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Abstract

Background: The role of left ventricular (LV) mechanical dispersion estimated after an ST elevation acute myocardial infarction (STEMI) remains unclear.

Methods: The study participants were 208 consecutive patients (152 men, age = 72 years) presenting with STEMI for the first time who underwent primary percutaneous coronary intervention (PCI) within 12 h of STEMI onset. Within 48 h of PCI (mean = 24 h), 2D and 3D speckle-tracking echocardiography were performed. The global longitudinal strain (GLS) was calculated using 3D (3D-GLS) and 2D (2D-GLS) speckle tracking. Mechanical dispersion was defined using the standard deviation (SD) of the time to regional peak longitudinal strain (LS) for all 16 segments for both 2D-STE and 3D-STE (2D-LS-SD, 3D-LS-SD). Infarct size was estimated by Tc99m-sestamibi as the total area of < 50% of the uptake area at 2 weeks. The patients were followed up for a longer period of time (median118months) and checked for major adverse cardiac events (MACE: cardiac death, heart failure).

Results: During follow-up, 55 patients experienced MACE. The cut-off values were determined using receiver operating characteristic curves. The multivariate analysis revealed that a 3D-LS-SD > 56.7 ms was a significant predictor of MACEs (hazard ratio = 1.991, 95% confidence interval 1.033-3.613, p = 0.03), but 2D-LS-SD > 58.1 ms was not an independent predictor of MACEs (hazard ratio = 1.577, 95% confidence interval 0.815-3.042, p = 0.1). Furthermore, the combination of 3D-GLS and 3D-LS-SD had accurate predictability for MACE, as shown by the Kaplan-Meier curves (log rank, χ² = 94.1, p < 0.0001).

Conclusions: LV mechanical dispersion besides 3D-GLS assessed by 3D-STE immediately after PCI can predict long-term prognosis.

Keywords: 2D, two-dimensional; 3D, three-dimensional; AMI, acute myocardial infarction; CI, confidence interval; GLS, global longitudinal strain; HF, heart failure; IQR, interquartile range; LV, left ventricular; Mechanical dispersion; Prognosis; STEMI; STEMI, ST-segment elevation myocardial infarction; Speckle tracking; Three dimensional echocardiography.