P802Longitudinal myocardial deformation can predict long-term recovery of segmental kinetics in ST-segment elevation myocardial infarction.


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Abstract

Purpose: The present study was designed to determine the prognostic value of longitudinal and transverse myocardial deformation parameters, based on speckle tracking, in predicting long-term recovery of segmental kinetics in ST-segment elevation myocardial infarction (STEMI).Methods: Prospective observational study of consecutive patients with STEMI, submitted to primary angioplasty. Echocardiographic study was performed in the first 24 to 72 hours of admission. The Wall Motion Score (WMS) was evaluated by two independent operators and the final classification was determined by consensus. Recovery was defined as improvement in regional wall motion with a decrease in segmental WMS of at least one point. In post-processing analysis the systolic peak of longitudinal strain (S) (SPLS), longitudinal strain rate (Sr) (SPLSr) and the protodiastolic peak of longitudinal Sr (DPLSr) were assessed. Their prognostic accuracy to predict recovery of segmental kinetics was determined by the area under the Receiver Operator Curve (AUC).Results: Fourty-four patients were included in the analysis (71% male; age 62±14 years). The image quality was adequate to evaluate longitudinal and transverse myocardial deformation in 775 left ventricle segments, 36% of which (N = 278) had abnormal segmental kinetics in the initial study (hypokinesia, akinesia and dyskinesia in 26.1%, 9.4% and 0.4%, respectively). In long-term follow-up regional wall motion improvement was observed in 19% of segments (N = 147). The WMS in the initial study did not predict the likelihood of long-term recovery, although full recovery was less frequent with initially akinetic segments. Segments with compromised basal contractile function (WMS ≥ 2) had significantly more negative basal SPLS (-10.4% vs -7.7%, p<0.001) and SPLSr (-0.75 vs -0.61 s-1, p=0.026) and higher DPLSr (0.97 vs 0.80 s-1, p=0.011). Basal transversal deformation parameters did not differ according to subsequent favourable evolution. The accuracy of each parameter of longitudinal myocardial deformation in the prediction of segmental kinetics improvement (considering segments with initial WMS ≥ 2) was only moderate: SPLS: AUC 0.62, 95% CI 0.55-0.69, p=0.002; SPLSr: AUC 0.58, 95% CI 0.51-0.66, p=0.026 and DPLSr: AUC 0.60, 95% CI 0.52-0.67, p= 0.011.Conclusion: Longitudinal myocardial deformation can predict the long-term recovery of segmental kinetics in STEMI. PSSL is the parameter with better prognostic accuracy.

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