Global myocardial strain assessment by different imaging modalities to predict outcomes after ST-elevation myocardial infarction: A systematic review

Table 5 All studies that have used speckle-tracking echocardiography-based strain to predict major adverse cardiac events

Ref.	Age (yr)	Sample size (male)	Baseline ejection fraction (%)	Timeframe baseline scan	Follow-up period	Outcome measures	Other parameters in multivariate model	Results	Limitations
Antoni et al[69]	60 ± 12	759 (517)	46.0 ± 8.0	2 d post-PPCI	21 ± 13 mo	GLS and/or GL-strain rate to predict: A: Mortality; B: Composite of revascularisation/readmission for HF/re-infarction	Age (A)	179 patients reached one or more endpoints; GLS independent predictor of all-cause mortality - HR = 1.2 (1.1-1.3), P = 0.002; GLS-R independent predictor of B endpoints - HR = 22 (11-48), P < 0.001; Both GLS and GLS-R independent predictors of combined A and B endpoints - HR = 1.1 (1 -1.1, P = 0.006) and 18 (10-35, P < 0.001) respectively	Sample size n < 1000 - potentially not large enough to predict "hard" events like mortality; Only longitudinal strain measured; SR analysis feasible in only 89% of segments
							HTN (A)
							Multi-vessel disease (A/B)
							Peak Trop (A)
							QRS duration (A/B)
							EF (A/B)
							Severe MR (A)
							Smoking (B)
							Diabetes (B)
Shanks et al[73]	59.7 ± 11.6	371 (288)	45.2 ± 8.0	2 d post-PPCI	17.3 ± 12.2 mo	GL-PEDSR to predict: Mortality; Readmission for HF; Re-infarction; Revascularisation	EF	Combined clinical endpoints occurred in 84 patients; GL-PEDSR does not predict clinical outcomes	Sample size potentially too small to assess "hard" endpoint such as mortality; No measure of GLS; Only longitudinal parameters obtained
							TIMI 0-1
							ESV-index
							Iso-volumetric relaxation SR
Woo et al[72]	64.4	98 (65)	52.6 ± 12.0	Pre-PPCI and 3 d post-PPCI	13.1 ± 3.8 mo	GLS to predict: Mortality; Readmission for HF	Initial Trop	7 patients developed endpoints; Pre-PPCI GLS predictor of outcomes - HR = 1.41 (1.01-1.98), P < 0.05; Post-PPCI GLS more likely to predict outcomes - HR = 2.34 (1.10-4.97), P < 0.05; Pre-PPCI GLS < 14% had sensitivity/specificity of 85%/75% respectively - post-PPCI GLS < 13% of 100%/89%	Very small sample size; Only longitudinal strain measured; Too many variables in multivariate analysis
							Initial NT-pro BNP
							EF (baseline)
							WMSI (follow-up)
							E/e’sr
							EF (follow-up)
							WSMI (follow-up)
Munk et al[78]	63.1	576 (446)	50.0 ± 10.0 (without composite endpoint), 47.0 ± 12.0 (with composite endpoint)	1 d post-PPCI	24 (IQ range 13-61) mo	GLS to predict: Mortality/re-infarction/stroke/hospitalisation for HF; Crude mortality	EF	162 patients experienced composite endpoints; GLS alone predicted outcomes within 1 yr post-MI - HR = 1.2 (1.12-1.29), P < 0.01; GLS alone could not predict outcomes later than 1yr post-MI	GLS could only be obtained in 74% of 576 patients - 26% excluded due to poor image quality (no difference in event rates, however); Only longitudinal strain measured
							WMSI
							ESV-index (Separately and in combination with each other)
Cong et al[71]	59.9 ± 11.6	127 (103)	51.8 ± 5.1	1 d post-PPCI	16.9 ± 1.6 mo	GLS to predict: Mortality; Development of HF	Anterior MI	GLS predicted outcomes - OR = 0.56 (0.34-0.91), P = 0.02; GLS > -9.55% had sensitivity/specificity of 83.3%/83.5% respectively	Sample size could potentially be too small to significantly predict "hard" events such as mortality
							Time to reperfusion
							∑ST before PPCI
							∑ST post-PPCI
							Raised CK-MB/Trops
							Baseline ESV/EF
							WMSI

CK: Creatine kinase; ESV: End systolic volume; GLS: Global longitudinal strain; HF: Heart failure; OR: Odds ratio; HR: Hazard ratio; HTN: Hypertension; IQ: Inter-quartile range; MR: Mitral regurgitation; PEDSR: Peak early diastolic strain rate; PPCI: Primary percutaneous coronary intervention; TIMI: Thrombolysis in myocardial infarction; WMSI: Wall motion score index; ∑ST: Sum of ST-elevation; MI: Myocardial infarction.