Speckle-tracking echocardiography in the early diagnosis of heart failure after ST-segment elevation myocardial infarction

Aim. To study the potential of global strain analysis using two-dimensional speckletracking echocardiography to predict the heart failure (HF) in patients with ST-segment elevation myocardial infarction (STEMI) based on the 6-month follow-up after revascularization.

Material and methods. The study included 114 STEMI patients aged 52 (44; 59) years. Two-dimensional echocardiography was performed with analysis of standard parameters and speckle tracking with analysis of strain and rotational characteristics of the myocardium. Concentration of brain natriuretic peptide was determined. The endpoint was the presence of heart failure (HF) after 6-month follow-up. observation. The analysis of HF risk was carried out using ROC-curves based on 3 criteria. Strain parameters with the maximum sum of sensitivity and specificity were chosen as a cutoff point.

Results. Six months after STEMI, depending on the ejection fraction (EF) value, the patients were divided into 3 groups: group 1 — patients with reduced EF (<40%) (HFrEF); group 2 — with mid-range EF (40-49%) (HfmrEF); group 3 — with preserved EF ≥50% (HFpEF). Strain and rotational characteristics differed between groups (p<0,001 for all). It was found that in the acute period of myocardial infarction, global longitudinal strain (GLS) <9,5% (AUR =0,804, 95% (confidence interval (CI) (0,673; 0,936), p=0,001) and global circumferential strain (GCS) <8,7% (AUR =0,722 (95% CI (0,568; 0,875), p=0,012) predicts the development of HFrEF. These values less than 12,5% (AUR =0,830 (95% CI (0,749; 0,911), p=0,001) and 13% (AUR =0,759 (95% CI (0,664; 0,855), p=0,001) is associated with HFmrEF The Twist had the highest predictive value in relation to HFrEF — 4,2° (AUR =0,998 (95% CI (0,993; 0,100), p=0,001).

Conclusion. GLS, GCS and Twist have high sensitivity and specificity and can be used in wide clinical practice as simple and cost-effective indicators of HF risk.

1. Schmidt M, Jacobsen JB, Lash TL, et al. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ. 2012;344:e356. doi:10.1136/bmj.e356.

2. Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7-13. (In Russ) doi:10.15829/1560-4071-2016-8-7-13.

3. Mareev VY, Fomin IV, Ageev FT, et al. Clinical recommendations. Heart failure: chronic (CHF) and acute decompensated (ODSN). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(S6):1-164. (In Russ.) doi:10.18087/cardio.2475.

4. McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787-847. doi:10.1093/eurheartj/ehs104.

5. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2016;29:277-314. doi:10.1016/j.echo.2016.01.01.

6. Munk K, Andersen NH, Nielsen SS, et al. Global longitudinal strain by speckle tracking for infarct size estimation. Eur J Echocardiogr. 2011;12(2):156-65. doi:10.1093/ejechocard/jeq168.

7. Marques-Alves P, Esprnto-Santo N, Baptista R, et al. Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”? Int J Cardiovasc Imaging. 2018;34(4):561-8. doi:10.1007/s10554-017-1269-x.

8. Ibanez В, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi:10.1093/eurheartj/ehx393.

9. Pieske B, Tschope C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40(40):3297-317. doi:10.1093/eurheartj/ehz641.

10. Mitchell C, Rahko PS, Blauwet LA, et al. ASE Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64. doi:10.1016/j.echo.2018.06.004.

11. Mareev YV, Garganeeva AA, Tukish OV, et al. Difficulties in diagnosis of heart failure with preserved ejection fraction in clinical practice: dissonance between echocardiography, NTproBNP and H2HFPEF score. Kardiologiia. 2019;59(12S):37-45. (In Russ.). doi:10.18087/cardio.n695.

12. Park CS, Park JJ, Mebazaa A, et al. Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction. J Am Heart Assoc. 2019;8(6):e011077. doi:10.1161/JAHA.118.011077.

13. Flachskampf FA, Schmid M, Rost C, et al. Cardiac imaging after myocardial infarction. European Heart Journal. 2011;32(3):272-83. doi:10.1093/eurheartj/ehq446.

14. Munk K, Andersen NH, Terkelsen CJ, et al. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr. 2012;25(6):644-51. doi:10.1016/j.echo.2012.02.003.

15. Ersboll M, Valeur N, Mogensen UM, et al. Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction. J Am Coll Cardiol. 2013;61(23):2365-73. doi:10.1016/j.jacc.2013.02.061.