Key result
Peak longitudinal strain derived from 2D-STE accurately identified transmural necrotic segments following acute myocardial infarction with an AUC of 0.98, performing significantly better than circumferential strain.
Why the study?
Does longitudinal strain measured by 2D-STE accurately reflect myocardial segmental viability following acute myocardial infarction in a porcine model?
Does longitudinal strain measured by 2D-STE accurately reflect myocardial segmental viability following acute myocardial infarction in a porcine model?
In a porcine model of acute myocardial infarction, peak longitudinal strain measured by 2D-STE is superior to circumferential and radial strain in identifying transmural myocardial necrosis.
Should not yet inform clinical viability assessment post-MI; leaves open translation of longitudinal strain superiority from porcine models.
BACKGROUND: The extension and the transmurality of the myocardial infarction are of high predictive value for clinical outcome. The aim of the study was to characterize the ability of longitudinal, circumferential and radial strain measured by 2-dimensional speckle tracking echocardiography (2D-STE) to predict the extent of necrosis in myocardial segments following acute myocardial infarction and to separate transmural necrotic segments from non-transmural necrotic segments in a full 18-segment porcine model. METHODS: 2D-STE strain was assessed in long- and short-axis following myocardial infarction in ten open-chest anesthetized pigs. Strain was defined according to systolic peak values. In segments displaying both negative and positive peaks, only the peak with the highest absolute value was utilized. Necrosis was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining and expressed as percent of each myocardial segment. RESULTS: Significant correlations were found between the extension of necrosis and all measured parameters of myocardial deformation (p < 0.001), but was stronger for longitudinal strain (r(2) = 0.52) than circumferential strain (r(2) = 0.38) and radial strain (r(2) = 0.23). The area under the receiver operator characteristic curve (AUC) for separating transmural necrotic segments (>50% necrosis) from predominantly viable segments (0-50% necrosis) was significantly larger for longitudinal strain (AUC = 0.98, CI = 0.97-1.00) when compared with circumferential strain (AUC = 0.91, CI = 0.84-0.97, p < 0.05) and radial strain (AUC = 0.90, CI = 0.83 - 0.96, p < 0.01), indicating a stronger ability of longitudinal strain to identify segments with transmural necrosis. CONCLUSION: Peak strain values derived from 2D-STE correlate well with the extent of necrosis in myocardial segments following acute myocardial infarction. Longitudinal strain most accurately reflects myocardial segmental viability in this setting.
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Aarsæther et al. (2012) studied Acute myocardial infarction (n=10). Longitudinal strain by 2-dimensional speckle tracking echocardiography (2D-STE) vs. Circumferential and radial strain was evaluated on Area under the receiver operator characteristic curve (AUC) for separating transmural necrotic segments (>50% necrosis) from predominantly viable segments (0-50% necrosis) (95% CI 0.97-1.00, p=<0.05). Peak longitudinal strain derived from 2D-STE accurately identified transmural necrotic segments following acute myocardial infarction with an AUC of 0.98, performing significantly better than circumferential strain.
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