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Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction
Author(s) -
Løgstrup Brian B.,
Høfsten Dan E.,
Christophersen Thomas B.,
Møller Jacob E.,
Bøtker Hans E.,
Pellikka Patricia A.,
Egstrup Kenneth
Publication year - 2012
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/j.1540-8175.2012.01784.x
Subject(s) - cardiology , medicine , microcirculation , myocardial infarction , strain (injury) , infarction
Objectives: We investigated the correlation between left ventricular global and regional longitudinal systolic strain ( GLS and LRS ) and coronary flow reserve ( CFR ) assessed by transthoracic echocardiography ( TTE ) in patients with a recent acute myocardial infarction ( AMI ). Furthermore, we investigated if LRS and GLS imaging is superior to conventional measures of left ventricle ( LV ) function. Methods: In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE . GLS and LRS were obtained from the three standard apical views. Assessment of CFR by TTE was performed in a modified apical view using color D oppler guidance. Results: The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty‐nine (49%) patients had a non‐ ST elevation myocardial infarction and 94 (51%) patients had a ST elevation myocardial infarction. The GLS was −15.2 [−19.3;−10.1]% in the total population of 183 patients. Total wall motion score index ( WMSI ) in the population was 1.19 [1;1.5]. Eighty‐five patients suffered from culprit lesion in left anterior descending artery ( LAD ). The CFR in these patients was 1.86 [1.36;2.35] and the GLS was −14.3 [−18.9; −9.8]%. A significant difference was observed in the LRS in LAD territory in culprit LAD infarction patients with a CFR ≤ 2 (−9.6 [−13.77;−6.44]) compared with the LRS in LAD territory in culprit LAD infarction patients with a CFR > 2 (−19.33 [−21.1;−16.5]), P < 0.0001. We found no significant difference between WMSI in LAD territory in culprit LAD infarction patients with a CFR ≤ 2 (1.56 [1.06;2.23]) compared with WMSI in LAD territory in culprit LAD infarction patients with a CFR > 2 (1.37 [1.03;2.11]); P = 0.18. The same pattern was observed in both circumflex coronary artery ( CX ) and right coronary artery ( RCA ) territories. In the total population, we found a strong correlation between CFR and GLS (r = −0.85, P < 0.0001). This was also seen in the multivariate regression model adjusting for possible confounders including WMSI (P < 0.001). Conclusion: In this study, we have shown a close association between myocardial deformation in patients with a recent AMI and the degree of diminished microcirculation. We found that both GLS and LRS correlated with CFR . We conclude that GLS and LRS are significantly better tools to assess impaired CFR and LV function after a recent AMI , than conventional echocardiographic measurements.