Korean Circ J.  2010 Dec;40(12):639-644. 10.4070/kcj.2010.40.12.639.

Predicting Myocardial Functional Recovery After Acute Myocardial Infarction: Relationship Between Myocardial Strain and Coronary Flow Reserve

• Park SM
• Hong SJ
• Kim YH
• Ahn CM
• Lim DS
• Shim WJ

• KMID: 2225162
• DOI: http://doi.org/10.4070/kcj.2010.40.12.639

Abstract

BACKGROUND AND OBJECTIVES
The purpose of this study was to evaluate the relationship between myocardial strain and coronary flow reserve (CFR) in the prediction of myocardial functional recovery after acute myocardial infarction (AMI).
SUBJECTS AND METHODS
Consecutive patients with anterior ST elevation AMI were analyzed. Left ventricular (LV) strain, determined by 2-dimensional speckle tracking imaging and CFR, determined by intracoronary flow measurement, were obtained on the same day, 3-5 days after primary percutaneous coronary intervention. A-strain was defined as the mean systolic longitudinal strain of 11 LV segments (out of 18) assumed to be supplied by the left anterior descending coronary artery (LAD). Functional recovery was defined as improved wall motion >1 grade seen in at least 2 contiguous dysfunctional segments by echocardiography at the 6-month follow-up.
RESULTS
Of 20 patients, 8 patients had preserved CFR (>2.0) and 12 patients had impaired CFR (< or =2.0). There were no differences between the 2 CFR groups in LV ejection fractions and wall motion score indices in the LAD territory. However, A-strain was greater in patients with preserved CFR than in patients with impaired CFR (-6.4+/-2.0% vs. -4.6+/-1.4%, p=0.03). A-strain and CFR correlated well with each other (r=-0.49, p=0.03). Ten of 20 patients showed functional recovery at 6 months. Of clinical and echocardiographic parameters, A-strain was the only predictor of recovery (odds ratio 2.02, 95% confidence interval=1.03-3.97, p=0.04). For predicting recovery, the sensitivity and specificity were 80.0% and 80.0%, respectively, for CFR (cutoff=1.60), and 60.0% and 90.0%, respectively, for A-strain (cutoff=-6.13%).
CONCLUSION
Myocardial strain correlates well with the extent of microvascular integrity and can be used as a noninvasive method for predicting recovery after AMI.

Keyword

Myocardial infarction; Strains

MeSH Terms

Coronary Vessels
Echocardiography
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Sensitivity and Specificity
Sprains and Strains
Track and Field

Figure

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  Fig. 1 Measurement of myocardial strain from apical 4- and 2-chamber and apical long axis views by 2-dimensional speckle tracking imaging.

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  Fig. 2 Intracoronary flow measurement of coronary blood flow velocity and coronary flow reserve (CFR). APV: average peak flow velocity, S: systolic, D: diastolic.

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  Fig. 3 Correlation between coronary flow reserve (CFR) and A-strain.

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