Information value of echocardiography in inferior myocardial infarction at different stages of observation

Abstract

BACKGROUND: A wide range of indicators and examination methods in acute myocardial infarction complicates their interpretation, affecting the objectivity and reliability of the final conclusions. In this situation, the results of a multivariate mathematical analysis can serve as a guide, allowing one to determine statistically significant indicators and establish a range of critical values for a particular case.

AIM: to establish prognostically significant ranges of global and segmental deformation of the left ventricle using speckle tracking echocardiography in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at the time of discharge from the hospital and in the long-term period.

METHODS: Using speckle-tracking technology, the echocardiographic data were analyzed at the time of discharge and on the second year for 144 patients with acute inferior myocardial infarction of the left ventricle who underwent percutaneous coronary intervention. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography.

RESULTS: Using the tree construction method, the critical values of 7 ultrasound parameters were identified (for the left ventricle — ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle — tricuspid S’, global longitudinal strain, free wall strain), which predict a repeat revascularization with a probability of 89.4%. The identification of the possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46–57%, specificity of 68–76%, and a negative predictive value of 74–87% relative to the gold standard detection of post infarction scarring by magnetic resonance imaging. According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercises were not accompanied by changes in the segmental longitudinal deformation.

CONCLUSION: The results of echocardiographic screening using speckle-tracking technology in patients with acute inferior myocardial infarction of the left ventricle have high prognostic significance in assessing the likelihood of repeated revascularization at the time of discharge and diagnostic information value for verifying post-infarction fibrous changes in the long-term period.

Keywords

inferior wall myocardial infarction / magnetic resonance imaging / speckle tracking echocardiography / decision tree

References

[1] Барбарич В.Б., Ложкина Н.Г., Толмачева А.А., и др. Создание калькулятора годичного прогноза с персональными коэффициентами факторов риска после перенесенного острого инфаркта миокарда с подъемом сегмента ST // Фундаментальная и клиническая медицина. 2020. Т. 5, № 2. С. 48-59. [Barbarich VB, Lozhkina NG, Tolmacheva AA, et al. Annual personalised calculator for prognostication after ST-segment elevation myocardial infarction. Fundamental and clinical medicine. 2020;5(2):48-59. (In Russ).] doi: 10.23946/2500-0764-2020-5-2-48-59.

[2] Prastaro M, Pirozzi E, Gaibazzi N, et al. Expert review on the prognostic role of echocardiography after acute myocardial infarction. J Am Soc Echocardiogr. 2017;30(5):431-443.e2. doi: 10.1016/j.echo.2017.01.020

[3] Hattab FE, Radi FZ, Hara L, et al. [Inferior myocardial infarction: first Moroccan study of 103 cases. (In French)]. Pan Afr Med J. 2019;33:74. doi: 10.11604/pamj.2019.33.74.16047

[4] Nägele MP, Flammer AJ. Heart failure after right ventricular myocardial infarction. Curr Heart Fail Rep. 2022;19(6):375-385. doi: 10.1007/s11897-022-00577-8

[5] Акрамова Э.Г., Савельев А.А., Хамитова Р.Я., Власова Е.В. Комплексная оценка исходов острого инфаркта миокарда нижней стенки по данным эхокардиографии у пациентов после чрескожного коронарного вмешательства // Российский кардиологический журнал. 2023. Т. 28, № 7. С. 5438. [Akramova EG, Savelyev AA, Khamitova RYa, Vlasova EV. Comprehensive assessment of the outcomes of inferior wall myocardial infarction according to echocardiography in patients after percutaneous coronary intervention. Russian Journal of Cardiology. 2023;28(7):5438. (In Russ).] doi: 10.15829/1560-4071-2023-5438

[6] Стрюков Р.К. Разработка диагностического дерева на основе дерева принятия решений // Актуальные проблемы прикладной математики, информатики и механики: сборник трудов Международной научно-технической конференции, 16–18 декабря 2015 г. Воронеж, 2015. С. 265-267. [Stryukov RK. Development of a diagnostic tree based on the decision tree. In: Actual problems of applied mathematics, computer science and mechanics: Proceedings of the International Scientific and Technical Conference, 16-18 December 2015. Voronezh; 2015. P. 265-267. (In Russ).]

[7] Гринхальх Т. Основы доказательной медицины / пер. с англ. под ред. И.Н. Денисова. 4-е изд. Москва: ГЭОТАР-Медиа, 2019. 286 с. [Grinhalch T. Fundamentals of evidence-based medicine. Transl. from Engl. ed. by I.N. Denisov. 4th ed. Moscow: GEOTAR-Media; 2019. 286 p. (In Russ).]

[8] Polacin M, Karolyi M, Eberhard M, et al. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images. Sci Rep. 2021;11(1):12376. doi: 10.1038/s41598-021-90283-7

[9] McDonagh T, Metra M. 2021 Рекомендации ESC по диагностике и лечению острой и хронической сердечной недостаточности // Российский кардиологический журнал. 2023. Т. 28, № 1. С. 5168. [McDonagh T, Metra M. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2023;28(1):5168. (In Russ).] doi: 10.15829/1560-4071-2023-5168

[10] Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063

[11] Guo Q, Wang X, Guo RF, et al. The value of CMR high-risk attributes in predicting ventricular remodeling in ST-segment-elevation myocardial infarction patients with mildly reduced or preserved ejection fraction. Zhonghua Xin Xue Guan Bing Za Zhi. 2022;50(9):864-872. doi: 10.3760/cma.j.cn112148-20220611-00462

[12] Yu F, Tang G, Chen YA, et al. Number of segments with motion abnormalities is better correlated with infarct size in acute myocardial infarction. Coron Artery Dis. 2023;34(7):489-495. doi: 10.1097/MCA.0000000000001266

RIGHTS & PERMISSIONS

Eco-Vector