Page 103 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

DISCUSSION
The main findings of the present study can be summarized as follows: in a contemporary STEMI population, patients with adverse remodeling have more impaired strain at all layers (endocardial, mid-myocardial and epicardial) when compared to their counterparts. Layer-specific LV GLS shows significant incremental value for prediction of adverse LV remodeling after adjusting for clinical, biological and echocardiographic variables. Finally, a model containing epicardial LV GLS appears to be the best fit model to predict adverse LV remodeling at 6 months follow-up.
LV remodeling and conventional two-dimensional echocardiography 5 Adverse remodeling still occurs in 30-40% of acute myocardial infarction patients,
even after PCI.1,21,22 This variation may be due to inhomogeneous patient populations
and different definitions of LV remodeling. In our study, we report an prevalence
of 36% for our patient population, which is similar to current literature. Two- dimensional transthoracic echocardiography plays a central role in the assessment of LV systolic function shortly after acute myocardial infarction.13,14 Conventional 2D-echocardiographic parameters such as LVEF and WMSI are still frequently used parameters and have shown to accurately predict LV remodeling.3,4 Previous studies have shown the superiority of WMSI over LVEF in the risk stratification after myocardial infarction.4,23 However, echocardiographic parameters such as WMSI and LVEF are limited by factors such as a geometrical assumptions, relatively high intra- and inter- observer variability, tethering of scar tissue by adjacent myocardial tissue and the need for trained observers.5
LV remodeling and advanced two-dimensional echocardiography
LV GLS by STE is a semi-automated, quantitative imaging technique which allows for the assessment of LV systolic function. Furthermore, STE derived LV GLS is independent of geometric assumptions, independent of angle and has relative low intra- and inter-observer variability.24 Recently a systematic review and meta-analysis by Huttin et al 25, evaluated the role of myocardial deformation imaging in patients after myocardial infarction. A total of 23 studies (3066 patients) were found eligible. Huttin et al 25 reported that LV GLS was the most superior parameter to detect the change in LV volumes during follow-up in several studies 25. In terms of adverse remodeling, a meta-regression analysis demonstrated a strong association between 2D LV GLS and adverse remodeling (increase LVEDV or LV-end systolic volume (LVESV) >15 to 20%) (pooled multivariable OR = 1.38, 1.13-1.70, p=0.002).25 Furthermore, a previous study by Joyce et al 6, retrospectively evaluated a large cohort of first STEMI patients (n=1041)
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