CLINICAL RESEARCH: CARDIAC IMAGING
Early Prediction of Infarct Size by Strain Doppler Echocardiography After Coronary Reperfusion
Trond Vartdal, MD*,1,
Harald Brunvand, MD, PhD*,
Eirik Pettersen, MD*,2,
Hans-Jørgen Smith, MD, PhD ,
Erik Lyseggen, MD, PhD*,1,
Thomas Helle-Valle, MD*,1,
Helge Skulstad, MD, PhD*,
Halfdan Ihlen, MD, PhD* and
Thor Edvardsen, MD, PhD*,*
* Department of Cardiology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway
Department of Radiology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
Manuscript received September 25, 2006;
revised manuscript received December 12, 2006,
accepted December 19, 2006.
* Reprint requests and correspondence: Dr. Thor Edvardsen, Department of Cardiology, Rikshospitalet University Hospital, 0027 Oslo, Norway. (Email: thor.edvardsen{at}klinmed.uio.no).
Objectives: The objective of this study was to investigate whether strain Doppler echocardiography performed immediately after revascularization by percutaneous coronary intervention could predict the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging (MRI).
Background: There is considerable variability in survival rate after percutaneous coronary intervention, and accurate early risk stratification is therefore of major clinical importance.
Methods: Thirty individuals with acute anterior myocardial infarction were examined with longitudinal strain by Doppler 1.5 h after revascularization. The extent of scarring 9 months later was analyzed by MRI in 16 corresponding myocardial segments. Strain in all left ventricular segments was averaged to obtain a global value. Infarct size was estimated by clinical parameters and cardiac markers.
Results: A good correlation was found between the global strain and total infarct size (R = 0.77, p < 0.00001). A multivariate regression analysis showed that global peak strain and serum glutamic oxaloacetic transaminase correlated with the infarct size measured by MRI (p = 0.0001 and p = 0.001, respectively). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment (R = 0.67, p < 0.0001).
Conclusions: This study demonstrates that assessment of regional and global strain at 1.5 h after reperfusion therapy correlates with size and transmural extent of myocardial infarction as determined by contrast-enhanced MRI. The novel global strain parameter is a valuable predictor of the total extent of myocardial infarction and may therefore be an important clinical tool for risk stratification in the acute phase of myocardial infarction.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | CK-MB = creatine kinase isoenzyme myocardial band | | ECG = electrocardiogram | | LAD = left anterior descending coronary artery | | LV = left ventricle | | LVEF = left ventricular ejection fraction | | MRI = magnetic resonance imaging | | PCI = percutaneous coronary intervention | | SGOT = serum glutamic oxaloacetic transaminase | | TDI = tissue Doppler imaging | | WMSI = wall motion score index |
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