Association between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with 6 MWT in Patients after Acute Myocardial Infarction
Author : P. Wulandari, T. Wasyanto, N. Purwaningtyas
Upload Date : 19-04-2018
Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardial myofibers. Thus, abnormalities in left ventricular (LV) global longitudinal strain (GLS) can be detected before reductions in LVEF. The 6MWT provides information that may be a better index of the patient’s ability to perform daily activities.
Methods: To assess the relationship between LV GLS and functional capacity measured with 6 minute walk test (6MWT) after Acute Myocardial Infarction (AMI), a cross sectional study was performed at Moewardi Hospital, Surakarta. Eligible patients underwent LV GLS 2D-STE that performed within 48 hour of admission and 6MWT pre-discharge or at the first follow-up visits.
Results: Fifty patients were divided into 2 groups, 32 patients with LV GLS > -13.8% (substansial infraction) and 18 patients with LV GLS < -13.8% (non substansial infarction). Patients with substansial infarction were more likely to be older (57.6 y.o vs 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 vs 392.39 ± 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% (OR =7.967; CI 95%: 1.669-38.030; p=0.009) and age >60 y.o (OR =10.898; CI 95%: 2.201-53.971; p=0.003) remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance < 375 m in patients after AMI.
Conclusion: In patients after AMI with LV GLS >-13.8% had less functional capacity and 6 MWT distance. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%.
KEYWORDS : Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.
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