Page 113 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Non-invasive evaluation of left ventricular (LV) systolic function by two-dimensional (2D) echocardiography remains one of the most important measures in clinical cardiology. 1
Although conventionally measured by means of the LV ejection fraction (EF), it has
become evident that this parameter is subject to a number of limitations.2 In addition,
LVEF can be normal in the presence of impaired LV systolic function, since it does not
reflect intrinsic myocardial contractility. 3 LV global longitudinal strain (GLS) measured
by speckle tracking echocardiography (STE) can overcome these limitations and has
shown to be an important prognostic parameter in the risk stratification of patients
after acute myocardial infarction.4 Furthermore, STE allows for an comprehensive
automated layer-specific analysis (endocardium, mid-myocardial, epicardium; respectively) of the LV myocardial wall. Especially in ischemic heart disease, layer-
specific analysis is of interest since the myocardial damage after acute myocardial 6 infarction may not be transmural.5 Layer-specific analysis of LV GLS has shown to
accurately discriminate between transmural and non-transmural myocardial infarction and has also been associated with outcome.6,7 Moreover, all-cause mortality is increased when LVEF<40%, however the prognostic value of low-normal range LVEF (40-50%) remains questionable.8Therefore, the aim of this study was to evaluate the prognostic value of multilayer LV GLS in a homogenous patient population with ST- segment elevation myocardial infarction (STEMI) and mildly reduced LVEF (40-49%) or preserved LVEF (≥50%).
METHODS
Patients admitted with acute STEMI at the Leiden University Medical Center (The Netherlands) and treated with primary percutaneous coronary intervention (PCI) were evaluated retrospectively. All patients were treated systematically according to an institutional guideline-based framework (MISSION!).9 Patients with incomplete follow- up data, 2D-echocardiographic data not suitable for speckle tracking analysis and known LVEF <45% prior to the index STEMI were excluded from this analysis (Figure 1). Demographic and clinical data were recorded at index admission. For retrospective analysis of clinically acquired data, the Institutional Review Board waived the need of patient written informed consent.
Clinical data were collected in the Cardiology Department Information System (EPD- Vision; Leiden University Medical Center, Leiden, The Netherlands). From the invasive
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