PONE-D-20-11858

Usefulness of serial postsystolic shortening by speckle tracking echocardiography to predict major adverse cardiovascular events and segmental function improvement after acute myocardial infarction

PLOS ONE

Dear Dr. Hsu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

There are several concerns noted by the reviewers below. Please adequately address these points as much as possible.

Please submit your revised manuscript by Sep 18 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Best regards,

John Lynn Jefferies, MD, MPH, FACC, FAHA

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In this submission, the author tried to evaluate if the serial analysis of postsystolic shortening (PSS) by speckle tracking echocardiography (STE) could predict major adverse cardiovascular events (MACE), especially symptom-driven infarct-related artery (IRA) revascularization, and the segmental function improvement in post-myocardial infarction patients. They found that PSS is independently predictive for IRA revascularization and MACE. Initial PSS is also related to regional wall motion recovery. However, there are several issues that need to be discussed.

1. The author used PSS to evaluate the LV function for patients with newly-onset acute myocardial infarction. But it is not clear about how to measure/calculate the initial and after-admission PSS for the whole LV? Was it the average PSS for all 16 or 18 segments? Or is it the average PSS for all segments that showed postsystolic shortening? The former one may seem more reasonable. What is more, how about the time interval between AVC and PSS peak, which reflect the dyssynchrony of the LV and just like the standard deviation for time to peak of either strain or strain rate for all 16 and 18 LV segments. Time related parameters are also essential for evaluating the LV function after PCI and prognosis.

2. Other questions for PSS: the author mentioned that PSS at 3rd month is the independently predictive of IRA revascularization and MACE. And Seventeen patients received symptom-driven IRA revascularization at the median time of 7.7 months after acute myocardial infarction during the follow-up. (1) How about the time for MACE? (2) Dose all IRA revascularization after 3 months after admission? Because the result seemed to show that PSS can only indicate the IRA revascularization and MACE after 3 months after admission. Please discuss why only PSS at 3rd month is predictive of IRA revascularization and MACE?

2. The author used 16 segment model when calculated the WMSI and used 18 segment model to measure the strain and strain rate. Because the patients were enrolled from 2010 to 2013 and the 12 months follow-up echocardiography examination were ended at around the July 2014, and the echo data were all recorded, so why the author did not use 17 segment model for both WMSI and speckle tracking imaging (at least for longitudinal strain) when they analyzed the data now? They used the averaged strain and strain rate from all 18 segment, and how about the left ventricular bullseye plots? The global strain could be gotten from the bullseye plots.

3. It was a little bit hard to follow how patients had been treat and followed up. For example, when patients were admitted into the hospital, did all the patients had PCI? The author mentioned that PCI was performed as early as possible with high success rate, and information about diseased vessels were recorded, but they also mentioned that coronary angiographies were not done for all patients in limitation. The author did not mention when did they had the first echocardiography examination before “limitation”, and it should be put down in the “method”. Did every patient had been followed up for 12 months? In the method, the author said that patients were followed up for 12 months, but the results showed that the follow-up time is 29.4 ± 12.7 months. How about the dropout rate? A figure or a table to illustration the detail could be helpful.

4. More details should be given when describing the angioplasty protocols, like did every patient underwent this procedure? How did the doctor decide when and whether the patient need the PCI? What is the definition about culprit vessel? Likewise, please provide the calculation formula for WMSI, and dose IRA revascularization include PCI and CABG?

5. How about the medicine use for enrolled patients when they admitted and during the follow-up? Did the hypertension and DM under control, because they might affect the MAC and IRA revascularization too.

Minor comments:

1. Then author mentioned that they used the 2009 and 2015 recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging when preforming echo. Dose it means that they use 2009 guidelines when doing the conventional echocardiography analysis, while use the 2015 guidelines when measuring the STE parameter?

2. Biochemical tests had been done immediately and at 8 hours and 16 hours later. Please make it clearer about the time point, like if it had been done 8 hours and 16 hours later after admission or PCI.

3. “The end of systole was defined as the first frame of the aortic valve in apical long-axis view, and each apical view or short-axis view was divided into 6 segments”. It should be “aortic valve close”. And “pule wave Doppler” should be better than “pulse wave velocity”.

4. For SPSS 21.0, it should belong to IBM Corp (Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp).

Reviewer #2: This study sought to determine, in patients presented with acute MI who were successfully treated with PCI, whether serial measurements of postsystolic shortening (PSS) by speckle tracking echocardiography could identify individuals at increased risk of developing major adverse cardiovascular events (MACE), and whether PSS could predict subsequent segmental wall motion recovery.

Ninety-four patients (84 males, 10 females) presented with either STEMI or NSTEMI were enrolled. Serial echocardiography was performed shortly after PCI and at 3-, 6- and 12-month follow-up. During a follow-up period of 29.4 ±12.7 months, 22 patients (23.4%) had MACE and 17 patients had symptom-driven IRA revascularization. Using multivariate Cox regression analysis, the authors concluded that PSS measured at 3-month follow-up was an independent predictor for symptom-driven IRA revascularization and MACE. In addition, segmental wall motion recovery could be predicted by initial strain, strain rate and PSS.

Major issues:

1. Calculation errors noted in Table 1.

In the Event-free group, 32 out of 72 patients (44.4%) had LAD being the culprit vessel, whereas in the Event group 14 out of 22 patients (63.6%) had LAD being the culprit vessel. The data will need to be reanalyzed.

2. In Table 1, the number of patients with LM disease should be separately listed, since LM disease is critically important prognostically.

3. In this study the MACE rate for female was 50% and for male 20%. The proportion of females was significantly higher in the Event group than in the Event-free group (22.7% vs. 6.9%). This raises the question whether the between-group differences noted in LS and PSS were largely driven by the disproportionate number of female patients in each group. Given low enrollment of female patients in this study perhaps this confounding variable can be circumvented by excluding female patients from the study.

Minor issues:

Numerous typographical and grammatical errors will need to be corrected at revision.

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Reviewer #1: Yes: Yijia Li

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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PONE-D-20-11858R1

Usefulness of serial postsystolic shortening by speckle tracking echocardiography to predict major adverse cardiovascular events and segmental function improvement after acute myocardial infarction

PLOS ONE

Dear Dr. Hsu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please address the remaining concerns of our Reviewers as noted below. 

Please submit your revised manuscript by Nov 28 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

John Lynn Jefferies, MD MPH FACC FAHA

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The author addressed some of the concerns in my review, but there are still some issues that need to be further discussed.

1. There is a parameter called time to peak, which should be provided with strain and strain rate by the software. It could make the manuscript more solid if the author adds that parameter as well.

2. In this study, 2 patients had IRA revascularization before 3 months after admission and the other 2 MACE events before 3 months. They did not have PSS at 3rd month. The author stated that PSS at 3rd month is independently predictive of IRA revascularization and MACE. These 5 patients should be excluded from the research.

3. Is it possible to reanalyzed the recorded echo imaging using the 17 segment model? According to my knowledge, EchoPAC provided a bullseye plot at least for longitudinal strain, and time to peak for strain and strain rate.

Reviewer #2: The authors did attempt to correct the calculation errors noted in Table 1. However, they have mistakenly placed the recalculated percentage values in the wrong column of the Table. Please revise.

(In the Event-free group, 32 out of 72 patients (44.4%) had LAD being the culprit vessel. In the Event group 14 out of 22 patients (63.6%) had LAD being the culprit vessel.)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Yijia Li

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Usefulness of serial post-systolic shortening by speckle tracking echocardiography to predict major adverse cardiovascular events and segmental function improvement after acute myocardial infarction

PONE-D-20-11858R2

Dear Dr. Hsu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Best regards,

John Lynn Jefferies, MD MPH FACC FAHA FHFSA

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors addressed my concerns and my comments in the review. I recommend acceptance for publication.

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Yijia Li

Reviewer #2: No