Clinical Investigation
Left Ventricular and Atrial Mechanics
Left Ventricle Longitudinal Deformation Assessment by Mitral Annulus Displacement or Global Longitudinal Strain in Chronic Ischemic Heart Disease: Are They Interchangeable?

https://doi.org/10.1016/j.echo.2009.04.023Get rights and content

Background

Increasing infarct mass is associated with impaired prognosis in chronic ischemic heart disease. Global strain by echocardiographic assessment relates closely to infarct mass assessed by delayed enhancement magnetic resonance imaging but requires deformation analysis in a 16-segment model of the left ventricular. Mitral annular (MA) displacement reflects longitudinal left ventricular deformation and could provide similar information.

Methods

Global longitudinal strain and MA displacement by Doppler tissue imaging were assessed in 61 patients 9 months after first myocardial infarctions and compared with global myocardial infarct mass assessed using contrast-enhanced magnetic resonance imaging.

Results

Both indices significantly separated medium-sized infarcts from small or large infarcts (P < .05) and correlated significantly with global infarct mass (P < .01 for both). There was a good correlation between global strain and MA displacement (r = 0.65, P < .01). The sensitivities and specificities to identify myocardial infarcts differed only slightly among the indices, but global longitudinal strain tended to be the best.

Conclusions

Longitudinal deformation by global strain or MA displacement correlated well with myocardial infarct mass and could discriminate between different extents of myocardial infarctions. Global longitudinal strain tended to be better, especially for the identification of the smallest infarcts.

Section snippets

Patients

Sixty-one patients (mean age 57 ± 10 years; 13 women) previously treated with primary percutaneous coronary intervention for acute ST elevation MIs were included in the study. Patients with contraindications to MRI were excluded, but no patients were excluded because of impaired echocardiographic image quality. The clinical data and infarct characteristics are displayed in Table 1, Table 2. Patients were examined with CE-MRI and echocardiography 9 months after the index MI, typically the same

Feasibility and Reliability

Infarct mass was analyzed in all (n = 976) LV segments using CE-MRI. The assessment of longitudinal strain was feasible in 93% of the LV segments and in ≥2 segments in 92% of the LV walls on 2D-STE. MA displacement or velocity was analyzed in 96% of the basal LV segments using DTI (P = ns vs strain). Remaining segments were excluded because of reverberations or poor image quality. Global deformation parameters were calculated as the averages of analyzed values in each patient.

Reliability

Discussion

The assessment of myocardial infarct size and transmural distribution provides prognostic information in acute or chronic MI,1, 2 even when the clinical event is not recognized.4

To our knowledge, the present study is the first to test the correlation between MA displacement by echocardiography and infarct mass assessed by CE-MRI, commonly accepted as the gold standard for clinical myocardial infarct size assessment. The mitral annulus is pulled toward the apex during systole by longitudinal

Conclusions

Global longitudinal strain and MA displacement and velocity indices correlate well with global infarct mass and distinguish among small, medium-sized, and large myocardial infarcts. Global strain is slightly better able to identify the smallest infarcts. The assessment of MA displacement is a clinically acceptable alternative to global longitudinal strain assessment in chronic ischemic heart disease.

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    Drs Gjesdal, Vartdal, and Lunde received research fellowships from the Norwegian Council on Cardiovascular Diseases (Oslo, Norway).

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