You are currently viewing Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients after Acute Myocardial Infarction.

Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients after Acute Myocardial Infarction.

Abstract

Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patients ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI.

Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre- discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS > -13.8%) and non-substantial infarction (LV GLS < -13.8%).

Results: There were 50 patients with 42 STEMI and 8 NSTEMI. Compared to patients in group LV GLS < -13.8% (n=18), patients in group LV GLS > -13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 1.3 ml/kg/min vs 11.04 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97 65.49 m vs392.39 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance < 375 m in patients after AMI with GLS >-13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003).

Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.

Keywords: Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.

Correspondence:Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java.

Indonesian Journal of Medicine (2017), 2(3): 192-206
https://doi.org/10.26911/theijmed.2017.02.03.07

Full Text:

PDF

References

Antoni ML, Mollema SA, Delgado V, et al. (2010). Prognostic Importance of Strain and Strain Rate after Acute Myocardial Infarction. Eur Heart Jour; 31: 16401647

Arena R, Myers J, Williams MA, et al. (2007). Assessment of Functional Capacity in Clinical and Research Settings. Circulation. 116: 329-343.

Baptista CB, Palhares LC, de Oliveira PPM, et al. (2012). Six minute Walk Test as a Tool for Assessing the Quality of Life in Patients Undergoing Coronary Artery Bypass Grafting Surgery. Rev Bras Cir Cardiovasc. 27(2):231-239

Borjesson M, Dellborg M (2005). Exercise testing post MI: still worthwhile in theinterventional era. Eur Heart J: 26; 105-106.

Buckberg G, Hoffman JIE, Mahajan A, et al. 2008. Cardiac mechanics revisited: The relationship of Cardiac Architecture to Ventricular Function. Circulation. 118:2571-2587.

Burke AP, Virmani R (2007). Pathophysiology of Acute Myocardial Infarction. Med Clin N Am 91(4): 553572.

Camici PG, Prasad SK and Rimoldi OE. 2008. Stunning, Hibernation, and Assessment ofMyocardial Viability. Circulation. 117:103-114.

Crapo RO, Casaburi R, Coates AL, et al. 2002. ATS statement: Guidelines for the Six minute Walk Test. Am J Respir Crit Care Mes; 166: 111-117

Crossman D.C, 2004. The Pathophysiology of Myocardial Ischaemia. Heart; 90: 576-580

De Bruyne B and Heyndrickx GR. 2007. Changes in Infarct Size and Left Ventricular Ejection Fraction New Prognostic Factors After Acute Myocardial Infarction? J Am CollCardiol: 50(2): 157-158.

Dharma S, Juzar DA, Firdaus I, et al. 2012. Acute myocardial infarction system of care in the third world.Neth Heart J 20(6): 254259.

Diao K, Yang Z, Ma M, et al. 2017. The Diagnostic Value of Global Longitudinal Strain (GLS) on Myocardial Infarction Size by Echocardiography: A Systematic Review and Metaanalysis. Scientific report; 7: 1-8

DimitriuLeen AC, Scholte AJ, Katsanos S, et al. 2017.Influence of Myocardial Ischemia Extent on Left Ventricular Global Longitudinal Strain in Patients after ST Segment Elevation Myocardial Infarction. Am J Cardiol; 119: 1-6

Dutcher JR, Kahn J, Grines C, et al. 2007.Comparison of left ventricular ejection fraction and exercise capacity as predictors of two and five year mortality following acute myocardial Infarction. Am J Cardiol; 99: 436441

Eek C, Grenne B, Braunvand H, et al. 2010. Strain Echocardiography and Wall Motion Score Index Predicts Final Infarct Size in Patients with Non ST Segment Elevation Myocardial Infarction. Circ Cardiovasc Imaging; 3: 187-194

Ekanayaka R and Waniganayake Y. 2013. Value of the 6 Minute Walk Test in Predicting Multi Vessel Coronary Arterial Disease. Open Journal of Internal Medicine; 3: 42-49.

Ersball MD. 2013. Left Ventricular Global Longitudinal Strain in Acute Myocardial Infarction. Dan Med J; 60(8): B4697

Fazlinejad A, Samadzade A, Bagheri R.K, et al. 2016. Does Global Longitudinal Speckle tracking Strain Predict Left Ventricular Remodeling in Patients with Myocardial Infarction? a Systematic review.RevClin Med; 3: 53-58

Ferreira PA, Ferreira PP, Batista AKM, et al. 2015. Safety of the six minute Walk Test in Hospitalized Cardiac Patients.Int J CardiovascSci; 1(1): 70-77.

Folta A, Metzger BL (1989). Exercise and Functional Capacity After Myocardial Infarction. Journal of nursing scholarship; 21(4): 215-219

Gerson C Jr, Bernadelli GF, Arena R, et al. 2010. Cardio Respiratory Responses of the Six Minute Walk test in Patients with Refractory Heart Failure during the Preoperative Period for Heart Transplant Surgery. Monaldi Arch Chest Dis; 74(2): 64-69

Gjesdal O, Hopp E, Vartdal T, et al. 2007. Global Longitudinal Strain Measured by Two Dimensional Speckle Tracking Echocardiography is Closely Related to Myocardial Infarct Size in Chronic Ischaemic Heart Disease. Clinical science. 113:287-296

Gjesdal O, Helle Valle T, Hopp E, et al. 2008. Noninvasive Separation of Large, Medium, and Small Myocardial Infarcts in Survivors of Reperfused ST elevation Myocardial Infarction: A Comprehensive Tissue Dopler and Speckle-Tracking Echocardiography Study. CircCardiovasc Imaging;1: 189-196

Gremeaux V, Troisgros O, Benaim S, et al. 2011. Determining the Minimal Clini cally Important Difference for the six Minute Walk Test and the 200 Meter Fast Walk Test during Cardiac Rehabilitation Program in Coronary Artery Disease Patients After Acute Coronary Syndrome. Arch Phys Med Rehabil; 92: 611-619

Hassan AKM, Dimitry SR and Agban GW. 2014. Can Exercise Capacity Assessed by the 6 Minute WalkTest Predict the Development of Major Adverse Cardiac Events in Patients with STEMI after Fibrinolysis?PLoS ONE 9(6): e99035. doi:10.1371/journal.pone.0099035

Hasselberg NE, Haugaa KH, Sarvari SI, et al. 2014. Left ventricular global longitudinal strain isassociated with exercise capacity in failing heartswith preserved and reduced ejection fraction. Eur Heart J Cardiovascular Imaging. 16: 217224.

Holmes JW, Borg TK, Covell JW. 2005. Structure and Mechanics of Healing Myocardial Infarcts. Annu Rev Biomed Eng;7:223253

Iacoviello M, Puzzovivo A, Guida P, et al. 2013. Independent Role of Left Ventricular Global Longitudinal Strain in Predicting Prognosis of Chronic Heart Failure Patients. Echocardiography; 30: 803811.

Irmalita, Juzar DA, Andrianto, et al. 2015. PedomanTatalaksanaSindromKoronerAkut. http: //jki.or.id.

Jneid H. 2016. Cardiac Rehabilitation After Myocardial InfarctionUnmet Needs and Future Directions. Article Information JAMACardiol; 1(9): 978-979

Kalam K, Otahal P and Marwick TH. 2014. Prognostic Implications of Global LV Dysfunction: a systematic review and metaanalysis of global longitudinal strain and ejection fraction. Heart; 0: 18.

Kearney LG, Lu K, Ord M, et al. 2012. Global Longitudinal Strain is a Strong Independent Predictor of All cause Mortality in Patients with Aortic Stenosis. Eur Heart J Cardiovasc Imaging. 13:827833

Kumler T, Gislason GH, Kober L, et al. 2010. Persistence of the Prognostic Importance of Left Ventricular Systolic Function and Heart Failure after Myocardial Infarction: 17 year followup of the trace register. European journal of heart failure;12:805-811

Loutfi M, Ashour S, El Sharkawy E, et al. 2010.Identification of High Risk Patients with Non ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging. Clin Med insights Cardiol; 10: 51-59

Minicucci MF, Farah E, Fusco DR, et al. 2014. Infarct Size as Predictor of Systolic Functional Recovery after Myocardial Infarction.Bras Cardiol.

Munk K, Andersen NH, Nielsen SS, et al. 2011.Global Longitudinal Strain by Speckle Tracking for Infarct Size Estimation. Eur J Echocardiogr; 12: 156-165

Nogueira P.A, Leal A.C.M, Nogueira E.D.B, et al. 2006. Clinical Reliability of the 6 Minute Corridor Walk Test Performed Within a Week of a Myocardial Infarction. Int Heart J; 47: 533-540.

Ndrepepa G, Kastrati A, Schwaiger M, et al. 2005. Relationship Between Residual Blood Flow in the InfarctRelated Artery and ScintigraphicInfarct Size, Myocardial Salvage, and Functional Recovery in Patients with Acute Myocardial Infarction. J Nucl Med; 46:17821788

Pires SR, Oliveira AC, Parreira VF, et al. 2007. Six Minutes Walk Test at Different Ages and Body Mass Indexes. Rev brasfisioter: 22(2): 131-134

Pollentier B, Irons SL, Benedetto CM, et al. 2010. Examination of the Six Minute Walk Test to Determine Functional Capacity in People with Chronic Heart Failure: a systematic review. Cardiopulm Phys Ther J; 21:13-21

Reed GW, Rossi JE, and Cannon CP. 2016. Acute myocardial infarction. Lancet 389(10065): 197210

Rosendahl L. 2010. Infarct Size and myocardial function.Faculty of Health Science, Linkping University Dissertation, No. 1169. http://www.liu.se/cmr.

Stanton T, Leano R and Marwick TH. 2009. Prediction of All-cause Mortality from Global Longitudinal Speckle Strain: Comparison with Ejection Fraction and Wall Motion Scoring. CircCardiovasc Imaging; 2: 356364

Scirica BM and Morrow DA. 2015. ST-Elevation Myocardial Infarction: Pathology, Pathophysiology, and Clinical Features. 10th ed. In: Mann DL, Zipes DP, Libby P, et al. (eds), Braunwalds Heart Disease A Textbook of Cardiovascular Medicine, Philadelphia: Elsevier, pp. 10681083

Swain DP, Brawner CA, Chambliss HO, et al. 2014. ACSMs Resources Manual for Guidelines for Exercise Testing and Prescription. 7th edition.Wolter Kluwer. Philadelphia

Thygesen K, Alpert JS, Jaffe AS, et al. 2012. Third universal definition of myocardial infarction.Eur Heart J 33(20): 25512567.

Valeur N, Clemmensen P, Saunamaki K, et al. 2005. The prognostic value of predischarge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI2 substudy. Eur Heart J. 26: 119 127.

Venkatesh N, Thanikachalam S, Murthy S, et al. 2011. Six Minute Walk Test: a Literary Review. SRJM; 4: 30-34.

Westhoff, Franke N, Schmidt S, et al. 2007. Beta blockers do not Impair the Cardiovascular Benefits of Endurance Training in Hypertensives. Journal of Human Hypertension: 21; 486-493.

Yingchoncharoen T, Agarwal S, Popovic ZB, et al. 2013. Normal Ranges of Left Ventricular Strain: A MetaAnalysis. J Am SocEchocardiogr; 26: 185-191.

Refbacks

  • There are currently no refbacks.

Leave a Reply