3D speckle tracking does not allow to characterize transmurality of myocardial necrosis in individual left ventricular segments

Aim: To assess the ability of 3D speckle tracking echo to differentiate transmural extent of myocardial infarction (MI), as defined by presence of delayedenhancement (DE) at cardiac magnetic resonance (CMR). Methods and results: 27 pts (age 60±14, 93% males) in sinus rhythm, with recent (8±4 days) recanalized STEMI (LVEF= 48±10%) underwent 3D echo and CMR (within 24 hrs) at pre-discharge. 4-beat full-volume data sets (30±2 vps) were acquired from the apical approach to measure segmental myocardial deformation in 4 directions: longitudinal (LS), circumferential (CS), radial, and area (AS, a combination of LS and CS) strain. In total, 440 LV segments were analysed and grouped according to transmurality: no MI (NI) = no DE (275 segm); nontransmural MI (NTI) = DE <50% (15 segm); and transmural MI (TI) = DE>50% of myocardial thickness (150 segm). Results of ANOVA to discriminate among different extents of transmurality are shown in Table and in Figure (CS only). Conclusions: 3D strains correlate with necrosis transmurality at CMR. CS showed the best discriminative power. However, the large overlap of NI, NTI and TI values does not allow to reliably predict necrosis transmurality in individual LV segments.