Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction

Purpose: Global measures of left ventricular (LV) function, in particular LV ejection fraction, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function and prognosis. We sought to describe regional cardiac function using 2D speckle tracking echocardiography and to evaluate the prognostic value of regional cardiac function on clinical outcomes in post myocardial infarction (MI) patients enrolled in the Valsartan in Acute Myocardial Infarction Trial (VALIANT) eho substudy. Methods: We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first MI from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS) and related these to clinical outcomes over 20 months follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Results: Regional LS (-7.68% (-11.23%, -4.87%)) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic (-10.44%±5.22%). In multivariate Cox Proportional Hazards models, the number of segments with normal LS was significantly associated with all-cause mortality (HR: 0.71, 95% CI: 0.54-0.93, P=0.01) even after adjustment for clinical covariates, including LV ejection fraction, LV end systolic volume, and number of normal segments by WMS. Figure 1. Regional wall motion score and regional longitudinal strain from healthy control and post myocardial infarction patients. Conclusions: In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and related to outcomes.