Skip to main content
SpringerLink
Log in

Longitudinal strain in remote non-infarcted myocardium by tissue tracking CMR: characterization, dynamics, structural and prognostic implications

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In ST-segment elevation myocardial infarction (STEMI) patients, longitudinal strain (LS) in remote non-infarcted myocardium (RNM) has not yet been characterized by tissue tracking (TT) cardiovascular magnetic resonance (CMR).

In STEMI patients, we aimed to characterize RNM-LS by TT-CMR and to assess both its dynamics and its structural and prognostic implications.

Methods

We recruited 271 patients with a first STEMI studied with TT-CMR 1 week after infarction. Of these patients, 145 underwent 1-week and 6-month TT-CMR and were used to characterize both the dynamics and the short-term and long-term structural implications of RNM-LS. Based on previously validated data, RNM areas were defined depending on the culprit coronary artery.

Results

Reduced RNM-LS at 1 week (n = 70, 48%) was associated with larger infarct size and more depressed left ventricular ejection fraction (LVEF) at both the 1-week and 6-month TT-CMR (p value < 0.001). Late normalization of RNM-LS was frequent (28/70, 40%) and independently related to late recovery of LVEF (p value = 0.002). Patients with reduced RNM-LS at 1-week TT-CMR had more major adverse cardiac events (death, heart failure or re-infarction) in both the 271 patients included in the study group (26% vs. 11%, p value = 0.002) and in an external validation cohort made up of 177 STEMI patients (57% vs. 13%, p value < 0.001).

Conclusion

After STEMI, reduced RNM-LS by TT-CMR is common and is associated with more severe short- and long-term structural damage. There is a beneficial tendency towards recovery of RNM-LS that parallels late recovery of LVEF. More events occur in patients with reduced RNM-LS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CMR:

Cardiovascular magnetic resonance

EF:

Ejection fraction

LAD:

Left anterior descending

LCX:

Left circumflex

LS:

Longitudinal strain

LV:

Left ventricular

MACE:

Major adverse cardiac events

RCA:

Right coronary artery

RNM:

Remote non-infarcted myocardium

STEMI:

ST-segment elevation myocardial infarction

TT:

Tissue tracking

References

  1. Abate E, Hoogslag GE, Antoni ML et al (2012) Value of three-dimensional speckle-tracking longitudinal strain for predicting improvement of left ventricular function after acute myocardial infarction. Am J Cardiol 110:961–967

    Article  Google Scholar 

  2. Gorcsan J 3rd, Tanaka H (2011) Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 58:1401–1413

    Article  Google Scholar 

  3. Khan JN, Singh A, Nazir SA et al (2015) Comparison of cardiovascular magnetic resonance feature tracking and tagging for the assessment of left ventricular systolic strain in acute myocardial infarction. Eur J Radiol 84:840–848

    Article  Google Scholar 

  4. Riffel JH, Keller MG, Aurich M et al (2015) Assessment of global longitudinal strain using standardized myocardial deformation imaging: a modality independent software approach. Clin Res Cardiol 104:591–602

    Article  Google Scholar 

  5. Buss SJ, Krautz B, Hofmann N et al (2015) Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement. Int J Cardiol 183:162–170

    Article  Google Scholar 

  6. Gavara J, Rodriguez-Palomares JF, Valente F et al (2018) Prognostic value of strain by tissue tracking cardiovascular magnetic resonance after ST-segment elevation myocardial infarction. J Am Coll Cardiol Img 11:1448–1457

    Article  Google Scholar 

  7. Granger CB, Goldberg RJ, Dabbous O et al (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353

    Article  Google Scholar 

  8. Ibanez B, James S, Agewall S et al (2018) 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 39:119–177

    Article  Google Scholar 

  9. Henriques JP, Zijlstra F, van’t Hof AW et al (2003) Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation 107:2115–2119

    Article  Google Scholar 

  10. Bodi V, Sanchis J, Lopez-Lereu MP et al (2005) Usefulness of a comprehensive cardiovascular magnetic resonance imaging assessment for predicting recovery of left ventricular wall motion in the setting of myocardial stunning. J Am Coll Cardiol 46:1747–1752

    Article  Google Scholar 

  11. Bodi V, Sanchis J, Nunez J et al (2009) Prognostic value of a comprehensive cardiac magnetic resonance assessment soon after a first ST-segment elevation myocardial infarction. J Am Coll Cardiol Img 2:835–842

    Article  Google Scholar 

  12. Ortiz-Perez JT, Rodríguez J, Meyers SN, Lee DC, Davidson C, Wu E (2008) Correspondence between the 17-segment model and coronary arterial anatomy using contrast-enhanced cardiac magnetic resonance imaging. J Am Coll Cardiol Img 1:282–293

    Article  Google Scholar 

  13. Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  Google Scholar 

  14. Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J 37:2129–2200

    Article  Google Scholar 

  15. Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER et al (2015) Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 17:29

    Article  Google Scholar 

  16. Bonanad C, Monmeneu JV, Lopez-Lereu MP et al (2016) Prediction of long-term major events soon after a first ST-segment elevation myocardial infarction by cardiovascular magnetic resonance. Eur J Radiol 85:585–592

    Article  Google Scholar 

  17. Rodriguez-Palomares JF, Gavara J, Ferreira-Gonzalez I et al (2019) Prognostic value of initial left ventricular remodeling in patients with reperfused STEMI. J Am Coll Cardiol Img 12:2445–2456

    Article  Google Scholar 

  18. Bodi V (2018) Strain by feature tracking: a short summary of the journey of CMR in STEMI. J Am Coll Cardiol Img 27:1199–1201

    Google Scholar 

  19. Podlesnikar T, Pizarro G, Fernández-Jiménez R et al (2018) Effect of early metoprolol during ST-segment elevation myocardial infarction on left ventricular strain: feature-tracking cardiovascular magnetic resonance substudy from the METOCARD-CNIC trial. J Am Coll Cardiol Img 12:1188–1198

    Article  Google Scholar 

  20. Ito S, Suzuki T, Hosokawa H et al (1999) Increased hyperkinesis in noninfarcted areas during short-term follow-up in patients with first anterior acute myocardial infarction treated by direct percutaneous transluminal coronary angioplasty. Jpn Heart J 40:549–560

    Article  CAS  Google Scholar 

  21. Bodi V, Sanchis J, Berenguer A et al (1999) Wall motion of noninfarcted myocardium. Relationship to regional and global systolic function and to early and late left ventricular dilation. Int J Cardiol 71:157–165

    Article  CAS  Google Scholar 

  22. Husser O, Chaustre F, Sanchis J et al (2012) Function of remote non-infarcted myocardium after STEMI: analysis with cardiovascular magnetic resonance. Int J Cardiol Img 28:2057–2064

    Article  Google Scholar 

  23. Reinstadler SJ, Stiermaier T, Liebetrau J et al (2018) Prognostic significance of remote myocardium alterations assessed by quantitative noncontrast T1 mapping in ST-segment elevation myocardial infarction. J Am Coll Cardiol Img 11:411–419

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the Instituto de Salud Carlos III and co-funded by Fondo Europeo de Desarrollo Regional (FEDER) [Grant Numbers PI17/01836, PIE15/00013, CIBERCV16/11/00486, CIBERCV16/11/00479 and a postgraduate contract FI18/00320 to C. R.-N.] and by the Generalitat Valenciana [Grant Number GV/2018/116]. JG and DM acknowledge financial support from the Agència Valenciana de la Innovació, Generalitat Valenciana (Grant INNCAD00/18/026).

Author information

Author notes

  1. Jose Gavara and Jose F. Rodriguez-Palomares contributed equally to this work

Authors and Affiliations

  1. Hospital Clínico Universitario de Valencia, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), University of Valencia, Blasco Ibanez 17, 46010, Valencia, Spain

    Jose Gavara, Cesar Rios-Navarro, Joaquim Canoves, Elena de Dios, Nerea Perez, Paolo Racugno, Clara Bonanad, Gema Minana, Victor Marcos, Julio Nunez, Francisco J. Chorro & Vicente Bodi

  2. Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain

    Jose Gavara & David Moratal

  3. Hospital Universitari Vall d’Hebron, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Jose F. Rodriguez-Palomares, Filipa Valente, Ignacio Ferreira-Gonzalez, Bruno Garcia del Blanco, Imanol Otaegui, Jose A. Barrabes & Arturo Evangelista

  4. Cardiovascular Magnetic Resonance Unit, Exploraciones Radiológicas Especiales (ERESA), Valencia, Spain

    Jose V. Monmeneu & Maria P. Lopez-Lereu

  5. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain

    Ignacio Ferreira-Gonzalez

  6. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain

    Elena de Dios, Antoni Bayes-Genis, Francisco J. Chorro & Vicente Bodi

  7. Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

    Antoni Bayes-Genis

  8. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    Antoni Bayes-Genis

Authors
  1. Jose Gavara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose F. Rodriguez-Palomares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cesar Rios-Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filipa Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jose V. Monmeneu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria P. Lopez-Lereu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ignacio Ferreira-Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bruno Garcia del Blanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Imanol Otaegui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Joaquim Canoves
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elena de Dios
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nerea Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Paolo Racugno
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Clara Bonanad
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Gema Minana
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Victor Marcos
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jose A. Barrabes
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Arturo Evangelista
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. David Moratal
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Antoni Bayes-Genis
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Julio Nunez
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Francisco J. Chorro
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Vicente Bodi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Cesar Rios-Navarro or Vicente Bodi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavara, J., Rodriguez-Palomares, J.F., Rios-Navarro, C. et al. Longitudinal strain in remote non-infarcted myocardium by tissue tracking CMR: characterization, dynamics, structural and prognostic implications. Int J Cardiovasc Imaging 37, 241–253 (2021). https://doi.org/10.1007/s10554-020-01890-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01890-w

Keywords

Search

Navigation