P1476Global longitudinal strain assessed by 2-D speckle tracking echocardiography identifies myocardial viability and predicts LV function and remodeling after acute MI with systolic dysfunction

Abstract Aims To assess whether two-dimensional speckle-tracking echocardiography (2D-STE) could (1) identify myocardial viability in comparison with late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR); (2) predict global left ventricular (LV) functional recovery and remodeling and (3) assess prognosis after acute myocardial infarction (MI) with LV systolic dysfunction. Methods Seventy one first STEMI patients with LVEF ≤45%, treated with acute percutaneous coronary intervention, underwent 2D-echocardiography for 2D-STE analysis and LGE CMR between 2 and 45 days after STEMI. Segments were defined as viable when transmural LGE extension was <50% and non viable when transmural LGE extension was ≥50%. At 8-month follow-up, transthoracic echocardiography was repeated to determine global LV functional recovery (increase in LVEF ≥5%) and LV remodeling (increase in end-systolic volume >15%) (n=30) and clinical outcomes were obtained (n=46). Results Global longitudinal strain (GLS) was lower in non viable than in viable infarct segments (−6.6±6.1% vs −10.3±5.9%, p<0.0001) and in viable infarct segments than in normal segments (−10.3±5.9% vs −14.5±6.4%, p<0.0001). GLS >−12% had sensitivity of 78% and specificity of 69% to identify non viable segments (area under the curve (AUC), 0.79; 95% confidence interval (CI), 0.77–0.81, p<0.0001). GLS >−11.3% had sensitivity of 53% and specificity of 100% to predict the absence of global functional improvement (AUC=0.73 (CI: 0.55–0.87) p=0.01) at 8-month follow-up. GLS <−12.5% predicted the absence of adverse LV remodeling at 8-month follow-up with a sensitivity of 100% and a specificity of 54% (AUC=0.83 (CI: 0.66–0.94) p<0.0001). GLS >−11.5% was associated with a poor prognosis. Conclusions In patients with recent first acute MI with LV systolic dysfunction, GLS assessed by 2D-STE: (1) is able to identify non viable segments in comparison with LGE CMR, (2) allows prediction of LV global functional recovery and LV remodeling at 8-month follow-up and (3) provides strong prognostic information, independently of LVEF.