Page 93 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Left ventricular (LV) remodeling is frequently observed after ST-segment elevation myocardial infarction (STEMI).1 LV remodeling is a complex and dynamic process that
occurs after STEMI and is a major determinant for short-term and long-term clinical outcomes.2 Two-dimensional (2D) echocardiographic variables such as LV ejection
fraction (EF) and wall motion score index (WMSI) have been associated with LV adverse remodeling in patients after myocardial infarction.3,4 However, these parameters are
limited by factors such as a geometrical assumptions, relatively high intra-observer
and inter-observer variability and the requirement for expert observers.5 LV global longitudinal strain (GLS) by 2D speckle tracking echocardiography (STE) has shown to
accurately assess global and regional LV systolic function.6,7 In addition, LV GLS has been 5 suggested as a marker of myocardial infarct size and has even shown to be correlated
to adverse LV remodeling.6,8,9 Novel advances in echocardiographic software allows for a more comprehensive analysis of the different LV myocardial layers (endocardial, mid- myocardial and epicardial) that form the myocardium. Particularly in ischemic heart disease, layer-specific analysis is of specific interest since the myocardial damage after STEMI may not be transmural. Layer-specific analysis of LV GLS has shown to accurately discriminate between transmural and non-transmural infarction and has been associated with prognosis.10,11 However, the association between layer-specific LV GLS and LV adverse remodeling remains unclear. The aim of this study was to evaluate the association between layer-specific LV GLS and LV adverse remodeling at 6 months follow-up in a cohort of contemporary STEMI patients.
METHODS
Population
Patients admitted with first acute STEMI to the Leiden University Medical Center (The Netherlands) and treated with primary percutaneous coronary intervention (PCI) between February 2004 and May 2013 were evaluated retrospectively. Patients with prior myocardial infarction, coronary artery bypass grafting, re-infarction, cardiac resynchronization therapy within 6 months after STEMI and patients with incomplete echocardiographic data were excluded from this analysis (Figure 1). All patients were treated systematically according to the institutional guideline-based protocol (MISSION!).12 Baseline 2D echocardiography was performed within 48 hours. In addition, patients received optimal guideline-based medical therapy.13,14 At 6 months of follow-up, the clinical and echocardiographic evaluation were performed according to the institutional clinical care protocol.
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