Longitudinal and Circumferential Strain Rate, Left Ventricular Remodeling, and Prognosis After Myocardial Infarction

OBJECTIVES: We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI). Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions.

METHODS: The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes.

RESULTS: Both longitudinal (mean: -5.1 ± 1.6 100/ms) and circumferential SRs (mean: -8.0 ± 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001).

CONCLUSIONS: Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI. 

PMID: 21087709

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2 Comments

  1. See post from March 7, 2010:

    Assessment of Myocardial Viability at Dobutamine Echocardiography by Deformation Analysis Using Tissue Velocity and Speckle-Tracking.
    Manish Bansal, Leanne Jeffriess, Rodel Leano, Julie Mundy, Thomas H. Marwick.
    JACC Imaging. 2010; 2(3):121-131.
    PMID:

  2. Tables 3 and 4 show some of the baseline echocardiographic characteristics of the patients stratified by quartiles for both the longuitudnal and circumferential strain rates, respectively. At the bottom the compare with 2 Doppler parameters, the E/A and the DT. The E/A has no statistically significant change on either table among different quartile groups, while the DT does.

    The authors do not elaborate much on this specific point. Does anyone with more experience on this would like to elaborate? Was this expected? What does it mean? Should more Doppler parameters have been measured (annular motion which may be close enough to longitudinal strain rendering the latter to cumbersome to adapt clinically?)

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