Key result
Apical longitudinal strain yielded higher diagnostic performance for left ventricular thrombus (AUC 0.83; 95% CI 0.72-0.93; P=0.001) than conventional wall motion assessment (AUC 0.73).
Why the study?
Does echocardiography-quantified myocardial strain improve the assessment of MI size and stratification of LV thrombus compared to conventional indices in patients with anterior ST-segment MI?
Observational (n=74)
Does echocardiography-quantified myocardial strain improve the assessment of MI size and stratification of LV thrombus compared to conventional indices in patients with anterior ST-segment MI?
Effect estimate: AUC 0.83 (95% CI 0.72-0.93)
Absolute Event Rate: 0.83% vs 0.73%
p-value: p=0.001
Echocardiography-quantified longitudinal strain provides a superior marker for MI size and post-MI LV thrombus stratification compared to conventional indices like LVEF and wall motion.
Apical strain may improve post-MI left ventricular thrombus detection over standard wall motion;.
BACKGROUND: Myocardial strain provides a novel means of quantifying subtle alterations in contractile function; incremental utility post-MI is unknown. OBJECTIVES: To test longitudinal-quantified by postprocessing routine echo-for assessment of MI size measured by cardiac magnetic resonance (CMR) and conventional methods, and assess regional and global strain (GLS) as markers of LV thrombus. METHODS: The population comprised of patients with anterior ST-segment MI who underwent echo and CMR prospectively. Preexisting echoes were retrieved, re-analyzed for strain, and compared to conventional MI markers as well as CMR-evidenced MI, function, and thrombus. RESULTS: Seventy-four patients underwent echo and CMR 4 ± 1 weeks post-MI; 72% had abnormal GLS. CMR-quantified MI size was 2.5-fold larger and EF lower among patients with abnormal GLS, paralleling 2.6-3.1 fold differences in Q-wave size and CPK (all P ≤ .002). GLS correlated with CMR-quantified MI (r = .66), CPK (r = .52) and Q-wave area (r = .44; all P ≤ .001): Regional strain was lower in the base, mid, and apical LV among patients with CMR-defined transmural MI in each territory (P < .05) and correlated with cine-CMR regional EF (r = .53-.71; P < .001) and echo wall motion (r = .45-.71; P < .001). GLS and apical strain were ~2-fold lower among patients with LV thrombus (P ≤ .002): Apical strain yielded higher diagnostic performance for thrombus (AUC: 0.83 [0.72-0.93], P = .001) than wall motion (0.73 [0.58-0.88], P = .02), as did global strain (0.78 [0.65-0.90], P = .005) compared to LVEF (0.58 [0.45-0.72], P = .41). CONCLUSIONS: Echo-quantified longitudinal strain provides a marker of MI size and improves stratification for post-MI LV thrombus beyond conventional indices.
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Kim et al. (2017) conducted an observational in anterior ST-segment MI (n=74). Echocardiography-quantified longitudinal strain vs. Conventional echocardiographic indices (wall motion, LVEF) was evaluated on Diagnostic performance for left ventricular thrombus (AUC 0.83, 95% CI 0.72-0.93, p=0.001). Apical longitudinal strain yielded higher diagnostic performance for left ventricular thrombus (AUC 0.83; 95% CI 0.72-0.93; P=0.001) than conventional wall motion assessment (AUC 0.73).
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