What is the clinical evidence from this study?

Study design: Cohort. Population: ST elevation myocardial infarction (STEMI) (n=208). Intervention: Left ventricular mechanical dispersion (3D-LS-SD > 56.7 ms) vs. 3D-LS-SD ≤ 56.7 ms. Primary outcome: Major adverse cardiac events (MACE: cardiac death, heart failure) (HR 1.991, 95% CI 1.033-3.613, p=0.03).

April 7, 2022Open Access

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

Key Result

Left ventricular mechanical dispersion > 56.7 ms assessed by 3D speckle-tracking echocardiography independently predicted major adverse cardiac events (HR 1.991) in patients with STEMI.

Study Design

Type

Cohort (n=208)

Multicenter

Structured PICO

Does left ventricular mechanical dispersion combined with global longitudinal strain assessed by 3D speckle-tracking echocardiography predict long-term MACE in patients with STEMI after primary PCI?

Population

208 adult patients presenting with their first ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours, followed for a median of 118 months.

Exposure

2D and 3D speckle-tracking echocardiography (assessing global longitudinal strain and mechanical dispersion) performed within 48 h of PCI (mean = 24 h).

Outcome

Major adverse cardiac events (MACE: cardiac death, heart failure) at median 118 months follow-up.composite

Left ventricular mechanical dispersion and global longitudinal strain assessed by 3D speckle-tracking echocardiography early after primary PCI for STEMI are predictive of long-term major adverse cardiac events.

Main Result

Hazard Ratio: 1.991 (95% CI 1.033–3.613)

p-value: p=0.03

Limitations

Retrospective, single-center study design
2D-STE and 3D-STE were performed using offline software
Echocardiographic examinations were performed at the bedside, making scanning sometimes difficult
Infarct size estimation was performed by scintigraphy rather than MRI
Potential for significant differences among strain values calculated using different vendor software
Relatively classical 3D machine (iE33) with a volume rate that was not high
Limited indices analyzed with the Cox hazard model due to the limited number of MACEs

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: = 94.1, p < 0.0001). Conclusions: LV mechanical dispersion besides 3D-GLS assessed by 3D-STE immediately after PCI can predict long-term prognosis.

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