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- Lehrkrankenhaus II. Medizinische Klinik Klinikum Coburg (1) (remove)
Introduction: Speckle-tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking obtained under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability.
Objective: To evaluate stress speckle tracking as tool to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients.
Methods: 49 patients were prospectively enrolled in our 18-month’s study. Dobutamin stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging (Speckle tracking) analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 6 weeks with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 6 weeks. We carried out an assessment of re-admission with acute coronary syndrome (ACS) after one year of enrollment.
Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. (R -0.69, p<0.01). Meanwhile it provided 81.82% sensitivity and 82.6% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Global stress strain rate showed 80% sensitivity and 77.5% specificity at a cut-off value of -9.1 to predict hospital re-admission with ACS. A cut-off value of -8.4 had shown a 69.23% sensitivity and 73.5% specificity to predict the re-admission related to other cardiac symptoms.
Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI .Moreover it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission.