| BackgroundBy tracking the "echo speckle" in the myocardium,two-dimensional(2D)and three-dimensional(3D)speckle tracking echocardiography(STE)are able to quantitatively evaluate myocardial deformation and movement in the direction of long axis,circumference and short axis,which may represent the systolic function of the heart in different directions.It has been confirmed that the two-dimensional(2D)global longitudinal strain(GLS)was able to predict left ventricular remodeling after acute myocardial infraction(AMI).Because the development of 3D STE is relatively late,whether the predictive value of the three-dimensional strain parameters is similar to that of 2D GLS is not clear,and few studies evaluate the different predictive value of multi-directional strain parameters derived from 3D STE.Whether the 3D mode is superior to 2D mode in this purpose is also not confirmed.ObjectiveThe aims of this study were to evaluate the value of multi-directional strain parameters derived from 3D STE for predicting left ventricular remodeling after ST-elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(PCI)compared with that of 2D GLS.The aims of this study were also to confirm the effect of changes of systolic function in different directions on left ventricular remodeling after AMI and explore the differences between 2D and 3D models in clinical applications.Our finding may provide a reference to select optimal strain parameters for predicting left ventricular remodeling.MethodsAt the Cardiology Department in the General Hospital of Guangzhou Military Command of People’ s Liberation Army(PLA)in Guangzhou,a total of 110 patients(mean age,54 ± 9 years)after STEMI treated with primary PCI(time to reperfusion<24h)were enrolled in our study between June 2015 and December 2015.Standard 2D echocardiography,2D STE and 3D STE were performed to acquire the conventional echocardiographic parameters and strain parameters after PCI.At 3-month follow-up,standard 2D echocardiography was measured again in all the patients to determine left ventricular remodeling,which was defined as an increase in left ventricular end-diastolic volumes(LVEDV)of greater than 20%.Results①At 3-month follow-up,left ventricular remodeling occurred in 26 patients(24%).Compared with patients without left ventricular remodeling,patients with left ventricular remodeling more frequently had left anterior descending artery(LAD)as the infarct-related artery(IRA)and higher cardiac troponin I(cTnI)level.Regarding echocardiographic parameters,patients with remodeling had significantly reduced 2D GLS(-12.5±3.2%vs-15.0±3.1%,P<0.001),3D GLS(-9.9±2.2%vs-13.1±2.7%,P<0.001),3D global area strain(GAS)(-20.3±3.%vs-23.3±4.8%,P=0.005)and 3D global radial strain(GRS)(29.0±7.4%vs 34.3±8.5%,P=0.007)when compared with patients without left ventricular remodeling at baseline,but there is no significant difference in 3D global circumferential strain(GCS)(-12.7±2.9%vs-13.0±3.2%,P=0.822)between two groups.②After the adjustment of the clinical and echocardiographic parameters(those with P values<0.10 in univatiate analysis),separated multivariate analysis showed that 2D GLS(OR=1.36,P=0.002),3D GLS(OR=1.82,=<0.001),3D GAS(OR=1.18,P=0.010)and 3D GRS(OR=0.90,P=0.007)were independent predictors of LV remodeling.③Receiver-operating characteristic(ROC)curve analysis showed that 2D GLS,3D GLS,3D GAS and 3D GRS was able to predict left ventricular remodeling(P<0.05),the area under the curve(AUC)of them was 0.72(95%IC:0.63-0.80),0.82(95%IC:0.0.73-0.88),0.68(95%IC:0.59-0.77),0.68(95%IC:0.58-0.77),respectively.However,3D GCS was unable to predict left ventricular remodeling(P>0.05).ROC curve analysis also showed that the AUC of 3D GLS(0.82)for predicting LV remodeling was significantly higher than that of 2D GLS,3D GAS and 3D GRS(P<0.05).④The correlation analysis showed that 2D GLS(r =-0.393,P<0.001),3D GLS(r=-0.512,P<0.001),3D GCS(r=-0.674,P<0.001))and 3D GAS(r=-0.667,P<0.001)was negatively correlated with LVEF,and 3D GRS was positively correlated with left ventricular ejection fraction(LVEF)(r = 0.668,P<0.001).⑤Image acquisition time(7.2±1.6 vs 4.2±1.4,P<0.001),analysis time(5.7±1.5 vs 4.7±1.7,P=0.019)and total time(12.9±2.3 vs 8.9±2.0,P<0.001)was significantly slower for 2D STE compared with 3D STE.ConclusionOur study confirmed that 2D GLS,3D GLS,3D GAS,and 3D GRS could be predictors of left ventricular remodeling 3 months after AMI,and 3D GLS was the most powerful predictor among them,suggesting that impaired longitudinal function might play an important role in left ventricular remodeling after AMI.This study also suggested that 3D STE is a more practical tool that is a potential alternative to 2D STE in prognosis evaluation in AMI patients. |
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