Copyright
©The Author(s) 2015.
World J Cardiol. Dec 26, 2015; 7(12): 948-960
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.948
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.948
Table 1 Advantages and disadvantages of speckle-tracking echocardiography vs cardiac magnetic resonance imaging
| Advantages | Disadvantages |
| Cheaper than CMR scan | Cannot acquire SAX views easily - needed to calculate circumferential strain |
| Can be performed at the bedside | Cannot routinely obtain stress imaging as part of acquisition protocol |
| Short duration: 10-20 min for STE vs 45-60 min for CMR | Not possible to ascertain infarct size, oedema, microvascular obstruction |
| Significant contraindications for CMR - for example, pacemaker/ICD, brain aneurysmal clip, claustrophobia, eGFR < 30 mL/min per 1.73 m2 - vs almost none for STE | CMR has much higher spatial resolution than STE. Consequently, a greater percentage of images are analysable by CMR than STE |
Table 2 Eligibility criteria for systematic review
| Type of characteristic | |
| Population type | Acute STEMI |
| Measured parameters | Global longitudinal and/or circumferential strain and/or strain rate - PSS or strain rate (PSS-R) or PEDSR |
| Imaging modalities | STE or cardiac MRI tagging or cardiac MRI FT |
| Timeframe for baseline scan | Days 0-14 post-STEMI |
| Outcomes reported | MACE or adverse LV remodelling |
| Timeframe for follow-up | MACE - ≥ 6 mo |
| Adverse LV remodelling - s ≥ 3 mo | |
| Year published | Within the last 20 yr |
Table 3 Keywords used for search of electronic databases
| "Cardiac MRI" OR "CMR" OR "magnetic resonance imaging [MeSH Term]" OR "cardiac magnetic resonance" OR "feature tracking" OR "tissue tracking" OR "tagging" OR "tag" OR "tagged" OR "SPAMM" OR "CPSAMM" OR "HARP" OR "SinMOD" OR "Echocardiography [MeSH Term]" OR "Speckle tracking", "2D speckle" OR "3D speckle" OR "two dimensional speckle" OR "three dimensional speckle". MIs were searched using "myocardial infarction [MeSH Term]" OR "acute MI" OR "STEMI" OR "ST elevation". Strain was searched using "strain" OR "myocardial strain" OR "strain rate" OR "deformation" OR "myocardial deformation" OR "systolic" OR "diastolic" OR "PSS" OR "PEDSR" OR "longitudinal" OR "circumferential". Outcomes were searched using "Predict" OR "Outcome" OR "Risk" OR "Prognosis" OR "Logistic Models [MeSH Term]" OR "risk" OR "multivariable" OR "multivariate" OR "odds" OR "MACE" OR "mortality [MeSH Term]" OR "remodelling" OR "remodelling" OR "adverse" OR "cardiac" OR "left ventricular" |
| Note: MeSH terms were only available on PubMed |
Table 4 All studies that have used speckle-tracking echocardiography-based strain to predict adverse left ventricular remodelling
| Ref. | Age (yr) | Sample size (male) | Baseline ejection fraction (%) | Timeframe baseline scan | Timeframe follow-up scan(s) | Definition of adverse remodelling | Other parameters in multivariate model | Results | Limitations |
| Bochenek et al[70] | 59.6 ± 10.3 | 66 (53) | 49.7 ± 9.2 | 4-6 d post-infarct | 3 mo | EDV > 20% | Diabetes | 22 patients remodelled; GLS can predict LV remodelling - OR = 1.19 (1.04-1.37), P < 0.05 - shown by multivariate analysis GLS > -12.5% can predict remodelling - AUC = 0.77 for ROC, sensitivity/specificity of 69%/79% respectively | Only longitudinal strain measured. Too many variables in multivariate analysis |
| Anterior MI | |||||||||
| Leuk. Count | |||||||||
| Time to reperfusion | |||||||||
| WMSI | |||||||||
| Max. Trop | |||||||||
| ST-elevation max pre-PCI | |||||||||
| Joyce et al[74] | 60 ± 12 | 1041 (792) | 47.0 ± 9.0 | 2 d post-PPCI | 3 and 6 mo | EDV ≥ 20% | Male sex | GLS > -15% can predict remodelling at 3 and 6 mo vs GLS < -15% (both P < 0.001): OR = 6.7 (2.8-11) for 3 mo; OR = 10 (6.7-14) for 6 mo | Only longitudinal strain measured; Prognostic data divided categorically - i.e., GLS > -15% or < -15%; Excluded patients with re-infarction before follow-up and cardiogenic shock - could potentially have been used as another endpoint |
| LAD infarct | |||||||||
| Max. Trop | |||||||||
| Discharge heart rate | |||||||||
| LA volume index | |||||||||
| WMSI | |||||||||
| Cong et al[71] | 59.9 ± 11.6 | 127 (103) | 51.8 ± 5.1 | 1 d post-PPCI | 6-9 mo | ESV ≥ 15% | Anterior MI | 41 patients developed remodelling; GLS predicted remodelling - OR = 0.39 (0.26-0.57), P < 0.01; GLS = -10.85% had sensitivity/specificity of 89.7%/91.7% respectively by ROC to predict remodelling | Only longitudinal strain measured; Too many variables in the multivariate analysis |
| Time to reperfusion | |||||||||
| ∑ST before PPCI | |||||||||
| ∑ST post-PPCI | |||||||||
| Raised CK-MB/Trops | |||||||||
| Baseline ESV/EF | |||||||||
| WMSI |
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 |
- Citation: Shetye A, Nazir SA, Squire IB, McCann GP. Global myocardial strain assessment by different imaging modalities to predict outcomes after ST-elevation myocardial infarction: A systematic review. World J Cardiol 2015; 7(12): 948-960
- URL: https://www.wjgnet.com/1949-8462/full/v7/i12/948.htm
- DOI: https://dx.doi.org/10.4330/wjc.v7.i12.948