Jörg Scharrenbroich | Sandra Hamada | Andras Keszei | Jörg

Schröder |
Andreas Napp | Mohammad Almalla | Michael Becker | Ertunc
Altiok
 LEFT VENTRICLE SYSTOLIC
ACUTE MYOCARDIAL ECHOCARDIOGRAPHY FOR
INFARCTION
FUNCTION AS A MAJOR
RISK STRATIFICATION
PREDICTOR OF OUTCOMES

LEFT VENTRICLE
EJECTION
FRACTION (LVEF)
FREQUENTLY USED
MEASUREMENT FOR
ECHOCARDIOGRAFIC
QUANTIFICATION FOR GLOBAL
WALL MOTION AND REGIONAL LVEF
SCORE INDEX
(WSMI)
 IN RECENT YEARS, MORE NOVEL ECHOCARDIOGRAPHIC
TECHNIQUES AS TISSUE DOPPLER IMAGING (TDI) AND 2-
DIMENSIONAL STRAIN ECHOCRDIOGRAPHY HAVE BEEN SHOWN TO
BE SUPERIOR THAN LVEF AND WMSI

majority of studies that have evaluated the usefulness

of novel myocardial deformation measures in patients with CAD
and AMI have mainly focused on the prognostic use of only global
longitudinal deformation parameters and rarely evaluated layerspecific
data (endocardial and epicardial myocardium).
 it is still unclear whether there is a difference in the
sensitivity or
characteristics of 2D STE parameters for the prediction
of prognosis
in patients with AMI or CAD
METHODS
 208 PATIENT SCREENED
IN 6 MONTH

INCLUSION CRITERIA
WAS SUCCESSFUL
REVASCULARIZATION

ACUTE MYOCARDIAL 94 PATIENT FORMED AMI

INFARCTION GROUP STUDY GROUP

54 PATIENT WITH STEMI

40 PATIENT WITH NSTEMI

 232 CONSECUTIVE PATIENT
SCREENED

INCLUSION CRITERIA IS
OPTIMAL MEDICAL THERAPY IN
LAT 3 MONTH AND CORONARY
REVASCULARIZATION
CORONARY ARTERY
DISEASE GROUP
137 PATIENT FORMD THE
CORONARY ARTERY DISEASE
GROUP

VALVULAR HEART DISEASE WAS

EXCLUDED
 USING STANDARD TECHNIQUE

 X RAY CORONARY ANGIOGRAPHY WAS PERFORMED

 CORONARY ANGIOGRAPHY STENOSIS CONSIDER RELEVANT WHEN >70%

REDUCTION OF VESSEL DIAMETER
 LEFT VENTRICLE
VIVID NINE SYSTEM EQUIPPED WITH A 2.5-MHz
PARASTERNAL SHORT AXIS
ECHOCARDIOGRAPH TRANSDUCER
BASAL, MID AND APICAL

TWO, THREE AND FOUR LVEF, END SYSTOLIC AND IN AMI GROUP,
CHAMBER VIEWS WERE END DIASTOLIC VOLUME ECHOCARDIOGRAPHY
ACQUIRED WERE ASSESED BY BIPLANE PERFORMED IN 48H OF CA
 Calculation of segmental
Analysis of global
Parasternal shortaxis at analyzed offline with strain values
circumfrential strain
basal, mid and apical software package (circumfrential strain and
(GCS) and global
level (echoPAC 113) longitudinal strain) for
longitudinal strain (GLS)
myocardial layers

All data were analyzed by

2 blinded experienced
cardiologist
RESULTS
Over the course of follow up, total 231
Patient were elderly and
patients were included in this
predominantly male
prospective single study

Patient with diabetes melitus 28% in Patient with hypercholeserolemia 36%

AMI group and 15% in CAD group in AMI group and 28% in CAD group

Patient treated with clopidogrel 91% in

AMI group and 12% in CAD group.
Other medication is similar
 Examined the association between
baseline risk factors and the occurence
of cardiac events in the study population

There is some suggestion of a

relationship between hypertension,
hpercholesterolemia and diabetes with
cardiac events
In CAD patient, the addition of endocardial
GCS could effectively increase the power
to predict cardiac event

LVEF is a robust prognostic marker of

adverse outcome

Endocardial GCS (along with gender, age,

baseline characteristics and LVEF)
effectively predict cardiac event in CAD
group
Strain parameters, did not predict cardiac
event in AMI better than the combination of
LVEF and baseline characteristic

Why these differences emerged is still

unclear
 CAD patients in the present
LV subclinical impairment has
study presented with higher
already been demonstrated by
frequency of DM and
2D STE in DM and
hypertension compared to AMI
Hypertension
patients

Similar in both patient groups

( 49% in AMI and 56% in CAD)

Subendocardial and
subepicardial fiber layers are
mainly arranged
longitudinally and contribute
to longitudinal LV function
decrease in circumferential
mid-myocardial fiber layers are
strain reflects more
mainly oriented
advanced transmural
circumferentially
interference from
with a major contribution to the
subendocardial to subepicardial
circumferential LV function.
layer
GCS may be more closely
related with viability
and cardiac events.
 The reserachers cannot exclude all influences, as some conditions, such as arterial
hypertension, are important risk factors for patients with CAD and AMI

 Contrast agents were not used in any echocardiographic examination, It is

speculative that image quality could potentially have improved and altered the
prognostic value of LVEF.
 layer-specific 2D
STE may be considered as a sensitive tool
that is capable of predicting
cardiac events in CAD patients, which may
not be detected using
conventional echocardiographic
parameters

2D STE fails
to increase the predictive power in patients
with AMI, probably due
to acute myocardial edema and myocardial
stunning.