Does global longitudinal speckle tracking strain predict left ventricular remodeling in patients with myocardial infarction? a systematic review
Introduction: Left ventricular remodeling is a relatively prevalent complication of acute myocardial infarction (AMI) and it is associated with higher rates of medical issues and mortality. Left ventricle ejection fraction (LVEF) and wall motion score index (WMSI) are unable to detect accurately minor lesions following AMI. Global longitudinal strain (GLS) which is obtained through 2D speckle tracking echocardiography (2D STE) provides an angle dependent measurement by which the infarcted area can be assessed as a means of identifying potential dysfunction. The main objective of this study was to evaluate whether GLS could adequately predict LV remodeling in AMI patients. Methods: The MEDLINE database from database inception to May 6th, 2015, was searched for relevant keywords and the reference lists of systematic reviews and eligible studies were also screened. All studies involving patients with their first reported case of AMI were examined for GLS by 2D STE and were evaluated for LV remodeling at a three month follow up point. Four English language prospective cohort studies were eligible for inclusion in this study.Result: A total of 291 AMI patients (mean age=57.92 years) were investigated across four different studies. The main finding of this study was that the most reliable and consistent measurement for the purposes of predicting LV remodeling in AMI patients is GLS obtained at the time of discharge, especially in STEMI patients.Discussion: In addition to their poor reproducibility, inability to stratify risks, and inter observer variability, compensatory hyperkinesis of intact myocytes and myocardial stunning after an AMI are among the main reasons why LVEF and WMSI may not be the most effective predictors of LV remodeling in AMI.Conclusion: GLS obtained by 2D STE at the time of discharge could be used as a reliable predictor of LV remodeling in AMI patients.