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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.

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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