A Significant Addition of Left Ventricular Fractional Shortening to Ejection Fraction correlated with Global Longitudinal Strain Value in Predicting Major Acute Cardiovascular Event in patients with Acute Coronary Syndrome
Abstract
Background: Global longitudinal strain (GLS) was a proven predictor of systolic function improvement and myocardial remodeling after acute coronary syndrome (ACS) for a residual left ventricular function defined their prognosis. However, not all echocardiography devices are equipped by speckle tracking (STE) as compare to the availability of M-mode modality which capable on assessing fractional shortening (FS) instead.
Methods: This study evaluated clinical and echocardiography parameters on myocardial infarction (MI) and non-MI ACS patients. Clinical outcome was defined as composite major acute cardiovascular event (MACE) on 6 months of follow up.
Results: Over 145 patients, GLS>-9.4% was found to be an independent predictor of MACE despite of troponin, age, ejection fraction (EF), prior reperfusion and infarct location [(HR 5.89 (1.82-16.51)]. There is negative correlation between FS and GLS (Spearman r -0,717; p<0,01). By using logistic regression analyses, it was found that the addition of FS<25% to biplane Simpson EF<50% could be useful to rule in the presence of GLS>-9.4% (AUC 0.831).
Conclusion: GLS had a prognostic value in patients with ACS. Left ventricular conventional M-mode FS in addition to Simpson EF were well correlated with GLS as well they can be considered as an alternative in predicting the incident of MACE in patient with ACS.
Keywords: global longitudinal strain, prognostic, fractional shortening, acute coronary syndrome
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References
1. Theorux P. "Pathogenesis of Stable and Acute Coronary Syndrome.Acute Coronary Syndromes: A Companion to Braunwald's Heart Disease. 2nd. Elsevier Saunders, 2011. 43-58.
2. Darma S, et al. Organisation of reperfusion therapy for STEMI in a developing country. Open Heart.2015; 2, e000240, doi:10.1136/openhrt-2015-000240.
3. Garza MA., Wason, EA., & Zhang, JQ. Cardiac remodeling and physical training post myocardial infarction. World J Cardiol. 2015; 7(2), 52-64.doi:10.4330/wjc.v7.i2.52.
4. Herzog E, Chaudhry F .Echocardiography in Acute Coronary Syndrome,Diagnosis, Treatment, and Prevention.Edited by Herzog E, Chaudhry F.London: Springer; 2010.
5. Mor-Avi V., Lang R M., & Bandano L. Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications Endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24: 277-313.
6. Hu B, Zhou Q, & Chen J. Prediction For Improvement and Remodeling In First-Onset Myocardial Infarction By Speckle Tracking Echocardiography: Is Global Or Regional Selection Better? Ultrasound in Med.& Biol. 2017; 1-9. doi:10.1016/j.ultrasmedbio.2017.06.001,
7. Skaarup KG, et al. The impact of cardiovascular risk factors on global longitudinal strain over a decade in the general population: the Copenhagen City Heart Study. The International Journal of Cardiovascular Imaging. 2020, doi: s10554-020-01906-5.
8. Huang SJ, Ting I, Huang AM, Mc.Lean A. Longitudinal wall fractional shortening: an M-mode index based on mitral annular plane systolic excursion (MAPSE) that correlates and predicts left ventricular longitudinal strain (LVLS) in intensive care patients. Critical Care. 2017: 21, 292. doi:10.1186/s13054-017-1876-x
9. Adachi Y, 2016. Left Ventricular Longitudinal Dysfunction Assessed By Longitudinal Fractional. Journal of American Colloege of Cardiology 2016; 67 (13) Supplement, p. 1645.
10. Ibanez B, James S, Agewal S, & Widimsky P. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2017: 1-66. doi:10.1093/eurheartj/ehx3.
11. Kaufmann D. Global longitudinal straincan predict heart failure exacerbation instable outpatients with schemic left ventricular systolic dysfunction.PLOS ONE,2019: 1-12. doi:10.1371/journal.pone.0225829.
12. Joyce E, Bax, JJ. Association Between Left Ventricular Global LongitudinalStrain and Adverse Left Ventricular Dilatation After ST-Segment–ElevationMyocardial Infarction. Circ Cardiovasc Imaging. 2014:7,74-81.doi:0.1161/CIRCIMAGING.113.000982.
13. Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circulation Journal. 2019: 10, 9098-931. doi:10.4070/kcj.2019.0200
14. Park K, Chang SA, Kim HK. Normal Ranges and Physiological Changes of Midwall Fractional Shortening in Healthy Korean Population. Korean Circulation Journal. 2010: 40, 587-592. doi:10.4070/kcj.2010.40.11.587
15. Niemeijer MN, Leening M, & Ven Den Berg ME. Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study. Journal of Cardiac Failure. 2016: 22(1), 17-23. doi:10.1016/j.cardfail.2015.06.007.
16. Luis, S.. Echocardiographic Assessment of Left Ventricular Systolic Function:An Overview of Contemporary Techniques including STE.Mayo Foundation for Medical Education and Journal Proceedings. 2019: 94(1), 125-138.
17. Amen L. Apical Rotation in Patients with ST-elevation Myocardial Infarction. Menoufia Medical Journal. 2016: 29(2), 412-417. doi:10.4103/1110-2098.192439.
18. Bermejo RA, et al. Determintants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings. Revista Espanola de Cardiologia. 2017: 71(10), 820-828. Doi: 10.1016/j.rec.2017.10.030
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