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Longitudinal Strain Is a Marker of Microvascular Obstruction and Infarct Size in Patients with Acute STSegment Elevation Myocardial Infarction

Abstract : Objectives: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI) in order to predict infarct size and functional recovery at 3-month follow-up. Methods: 44 patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.961.2 days after myocardial reperfusion, assessing circumferential (CGS), radial (RGS), and longitudinal global (GLS) strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR), for assessing cardiac function, infarct size, and microvascular obstruction (MVO), was conducted 5.662.5 days and 99.464.6 days after myocardial reperfusion. Results: GLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R = 0.601, p,0.001), RGS (R =20.405, p = 0.010), CGS (R = 0.526, p = 0.001), ejection fraction (R =20.699, p,0.001), wall motion score index (WMSI) (R = 0.539, p = 0.001), and left atrial volume (R = 0.510, p,0.001). Baseline ejection fraction and GLS were independent predictors of 3-month infarct size. MVO mass significantly correlated with GLS (R = 0.376, p = 0.010), WMSI (R = 0.387, p = 0.011), and ejection fraction (R =20.389, p = 0.011). In multivariate analysis, GLS was the only independent predictor of MVO mass (p = 0.015). Longitudinal strain .26.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia ($3 segments) at 3-month follow-up. Conclusions: Speckle-tracking strain imaging performed early after a STEMI is easy-to-use as a marker for persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.
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Loïc Bière, Erwan Donal, Gaëlle Kervio, Serge Willoteaux, Alain Furber, et al.. Longitudinal Strain Is a Marker of Microvascular Obstruction and Infarct Size in Patients with Acute STSegment Elevation Myocardial Infarction. PLoS ONE, Public Library of Science, 2014, 9 (1), pp.e86959. ⟨10.1371/journal.pone.0086959⟩. ⟨hal-00957360⟩

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