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Comparative left ventricular mechanical deformation in acute apical variant stress cardiomyopathy and acute anterior myocardial infarction utilizing 2‐dimensional longitudinal strain imaging
Author(s) -
Ahmed Mohamed,
Sardana Mayank,
Rasla Somwail,
Escobar Jorge,
Bote Josiah,
Iskandar Aline,
Tran KhanhVan,
Tighe Dennis A.,
Fitzgibbons Timothy P.,
Aurigemma Gerard P.
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14675
Subject(s) - basal (medicine) , medicine , cardiology , myocardial infarction , area under the curve , radial stress , nuclear medicine , deformation (meteorology) , physics , meteorology , insulin
Aims Despite three decades of study, it is still challenging to discriminate acute apical variant stress cardiomyopathy (AVSCM) from acute left anterior descending‐myocardial infarction (LAD‐MI) at the time of presentation. A biomarker or practical imaging modality that can differentiate these two entities is highly desirable. Our objective was to characterize left ventricular (LV) mechanical deformation using 2‐dimensional (2D) echocardiographic strain imaging in an attempt to discriminate AVSCM from LAD‐MI at presentation. Methods and Results We studied 108 women (60 AVSCM, 48 ST segment elevation LAD‐MI). All underwent echocardiography within 48 hours of presentation. 2D longitudinal strain (LS) from an 18‐segment LV model was performed, with global LS (GLS) taken as the average of all 18 segments. GLS was abnormal, but did not differentiate AVSCM from LAD‐MI. Mean LS of the basal and mid‐anterior, basal, and mid‐anteroseptum segments were significantly lower in LAD‐MI vs AVSCM group (−14 ± 9% vs −20 ± 8%; −11 ± 7% vs −14 ± 6%; −9 ± 8% vs −14 ± 8%; −9 ± 7% vs −13 ± 5%, respectively, all P ≤ .05). Mean LS of the basal inferior and inferolateral segments was significantly higher in the LAD‐MI vs. AVSCM group (−19 ± 9% vs −13 ± 7%; −23 ± 11% vs −18 ± 7%, respectively, all P ≤ .05). Using ROC curve analysis, segmental strain ratio of average basal inferior and inferolateral segments LS to average mid‐ and basal anterior and anteroseptum segments LS of ≥1.58 was 90% specific for LAD‐MI [area under the curve (AUC) 0.87; P < .001]. Conclusion Longitudinal strain patterns are useful in discriminating AVSCM from LAD‐MI patients at presentation and may be valuable in stratifying patients for invasive evaluation.