Usefulness of Speckle-Tracking Imaging for Right Ventricular Assessment after Acute Myocardial Infarction: A Magnetic Resonance Imaging/Echocardiographic Comparison within the Relation between Aldosterone and Cardiac Remodeling after Myocardial Infarction Study

doi:10.1016/j.echo.2015.02.019

Journal of the American Society of Echocardiography

Volume 28, Issue 7, July 2015, Pages 818-827.e4

https://doi.org/10.1016/j.echo.2015.02.019 Get rights and content

Background

Right ventricular (RV) dysfunction after acute myocardial infarction (AMI) is frequent and associated with poor prognosis. The complex anatomy of the right ventricle makes its echocardiographic assessment challenging. Quantification of RV deformation by speckle-tracking echocardiography is a widely available and reproducible technique that readily provides an integrated analysis of all segments of the right ventricle. The aim of this study was to investigate the accuracy of conventional echocardiographic parameters and speckle-tracking echocardiographic strain parameters in assessing RV function after AMI, in comparison with cardiac magnetic resonance imaging (CMR).

Methods

A total of 135 patients admitted for AMI (73 anterior, 62 inferior) were prospectively studied. Right ventricular function was assessed by echocardiography and CMR within 2 to 4 days of hospital admission. Right ventricular dysfunction was defined as CMR RV ejection fraction < 50%. Right ventricular global peak longitudinal systolic strain (GLPSS) was calculated by averaging the strain values of the septal, lateral, and inferior walls.

Results

Right ventricular dysfunction was documented in 20 patients. Right ventricular GLPSS was the best echographic correlate of CMR RV ejection fraction (r = −0.459, P < .0001) and possessed good diagnostic value for RV dysfunction (area under the receiver operating characteristic curve [AUROC], 0.724; 95% CI, 0.590–0.857), which was comparable with that of RV fractional area change (AUROC, 0.756; 95% CI, 0.647–0.866). In patients with inferior myocardial infarctions, the AUROCs for RV GLPSS (0.822) and inferolateral strain (0.877) were greater than that observed for RV fractional area change (0.760) Other conventional echocardiographic parameters performed poorly (all AUROCs < 0.700).

Conclusions

After AMI, RV GLPSS is the best correlate of CMR RV ejection fraction. In patients with inferior AMIs, RV GLPSS displays even higher diagnostic value than conventional echocardiographic parameters.

Section snippets

Study Population

The study population encompassed all patients with successfully reperfused first acute ST-elevation myocardial infarctions (STEMIs) included in a prospective monocentric cohort study (Relation between Aldosterone and Cardiac Remodeling after Myocardial Infarction [REMI]) performed in a university hospital between April 2010 and October 2013. Approval of the institutional review board and informed consent were obtained before inclusion. The REMI study was designed primarily to determine whether

Baseline Characteristics

Baseline population characteristics are listed in Table 1. The mean age was 55.2 ± 10.6 years, with the majority of patients being men (117 of 135 [87%]). Sixty-two patients (45.9%) had inferior MIs, of whom nine had inferolateral MIs, and 73 patients (54.1%) had anterior MIs, of whom 36 had anterolateral AMIs.

Reperfusion therapy was achieved with a median delay of 180 min (interquartile range, 150–330 min) after symptom onset. The mean peak creatine phosphokinase level was 2,639 ± 1,763 IU/L.

Discussion

The major findings of the present study are that (1) RV GLPSS is a valuable echocardiographic variable in identifying RV dysfunction in patients with AMIs, and (2) among conventional and STE-derived parameters, RV GLPSS is the parameter most closely correlated with RVEF by CMR, which is currently considered the gold standard.

These findings suggest that RV GLPSS could potentially be more useful than other widely used echocardiographic parameters, such as RVFAC, in assessing RV function in

Conclusions

RV GLPSS, an integrative parameter taking into account the contribution of the septal, lateral, and inferior walls of the right ventricle, is useful in assessing RV function after MI. Importantly, RV GLPSS is better correlated with RVEF by CMR than conventional echocardiographic tools. As is the case for the left ventricle, assessment of several walls of the right ventricle appears essential in the setting of regional myocardial ischemic insult for evaluating RV function.

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Another approach to quantify RV systolic function is the measurement of RV longitudinal strain. Prior studies have established its diagnostic and prognostic values in various cardiac pathologies.14-16 With the advent of 3D-STE, it has been increasingly used to quantify RV strain.17-20
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The assessment of right ventricular anatomy and function is important in several pathologies. This chapter depicts the importance of assessing the right ventricle and summarizes the main noninvasive techniques used for right ventricular evaluation, including echocardiography, radionuclide angiography, multislice computed tomography, and cardiovascular magnetic resonance. Also, imaging strategies with cardiovascular magnetic resonance are reviewed and normal values of reference for right ventricular dimensions and function are provided. Finally, a brief summary of right ventricular assessment in a number of heart diseases is included.

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: The REMI study and the STANISLAS cohort were supported by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique Inter-Régional 2008 and 2009) and sponsored by the CHU Nancy (Nancy, France). CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov/show/NCT01109225; NCT01109225

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Background

Methods

Results

Conclusions

Section snippets

Study Population

Baseline Characteristics

Discussion

Conclusions

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Soc Echocardiogr

Am Heart J

J Am Coll Cardiol

Prog Cardiovasc Dis

J Am Soc Echocardiogr

J Am Coll Cardiol

Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle

Circulation

Right ventricular function by MRI

Curr Opin Cardiol

Speckle-tracking echocardiography a new technique for assessing myocardial function

J Ultrasound Med

Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: meta-analysis

Crit Care Med