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Echocardiography. 2017 Nov;34(11):1623-1632. doi: 10.1111/echo.13668. Epub 2017 Aug 22.

Echocardiography-quantified myocardial strain-a marker of global and regional infarct size that stratifies likelihood of left ventricular thrombus.

Author information

1
Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA.
2
Departments of Surgery and Bioengineering, University of California, San Francisco, CA, USA.
3
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

BACKGROUND:

Myocardial strain provides a novel means of quantifying subtle alterations in contractile function; incremental utility post-MI is unknown.

OBJECTIVES:

To test longitudinal-quantified by postprocessing routine echo-for assessment of MI size measured by cardiac magnetic resonance (CMR) and conventional methods, and assess regional and global strain (GLS) as markers of LV thrombus.

METHODS:

The population comprised of patients with anterior ST-segment MI who underwent echo and CMR prospectively. Preexisting echoes were retrieved, re-analyzed for strain, and compared to conventional MI markers as well as CMR-evidenced MI, function, and thrombus.

RESULTS:

Seventy-four patients underwent echo and CMR 4 ± 1 weeks post-MI; 72% had abnormal GLS. CMR-quantified MI size was 2.5-fold larger and EF lower among patients with abnormal GLS, paralleling 2.6-3.1 fold differences in Q-wave size and CPK (all P ≤ .002). GLS correlated with CMR-quantified MI (r = .66), CPK (r = .52) and Q-wave area (r = .44; all P ≤ .001): Regional strain was lower in the base, mid, and apical LV among patients with CMR-defined transmural MI in each territory (P < .05) and correlated with cine-CMR regional EF (r = .53-.71; P < .001) and echo wall motion (r = .45-.71; P < .001). GLS and apical strain were ~2-fold lower among patients with LV thrombus (P ≤ .002): Apical strain yielded higher diagnostic performance for thrombus (AUC: 0.83 [0.72-0.93], P = .001) than wall motion (0.73 [0.58-0.88], P = .02), as did global strain (0.78 [0.65-0.90], P = .005) compared to LVEF (0.58 [0.45-0.72], P = .41).

CONCLUSIONS:

Echo-quantified longitudinal strain provides a marker of MI size and improves stratification for post-MI LV thrombus beyond conventional indices.

KEYWORDS:

cardiac magnetic resonance imaging; echocardiography; strain

PMID:
28833519
PMCID:
PMC5985969
DOI:
10.1111/echo.13668
[Indexed for MEDLINE]
Free PMC Article

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