Value of Two-Dimensional Strain Imaging in Prediction of Myocardial Function Recovery After Percutaneous Revascularization of Infarct-Related Artery

Abstract

Background: Acute myocardial infarction (MI) is often accompanied by impaired regional myocardial systolic function. A novel approach known as two-dimensional speckle tracking echocardiography was used to quantify regional LV function. Objective: The aim of the current study was to evaluate of the role of Speckle Tracking Echocardiography in prediction of left ventricular function recovery after percutaneous coronary intervention to left anterior descending coronary artery in patients with anterior ST segment elevation myocardial infarction with impaired left ventricular ejection fraction. Patients and methods: This study included 50 patients and 15 normal control adult persons. Patients had suffered from first attack of anterior STEMI. They were admitted at the CCU units of Al-Azhar University Hospitals from September 2016 to September 2018 and treated with thrombolytic therapy. Each patient was subjected to conventional transthoracic echocardiography before hospital discharge and before reperfusion. Speckle tracking echocardiography and resting SPECT were done one week after MI. Percutaneous coronary intervention to LAD within one week after MI for patients with demonstrated myocardial viability by resting SPECT. Three months after percutaneous revascularization to LAD, all patients were reevaluated using conventional TTE and strain imaging. The studied population were divided into 2 Groups; group A: 24 patients who showed post-PCI LV function recovery and Group B: 26 patients who did not showed post-PCI LV function recovery. Results: There was statistically significant increase in the prevalence of diabetes mellitus, smoking and dyslipidemia in group B. There was high statistically significant difference between the two groups as regard baseline LVEF (%), baseline wall motion score index (WMSI), mean baseline and follow up WMSI values, baseline number of affected left anterior descending (LAD) segments as assessed by WMSI, baseline and 90 days follow up mean number of affected LAD segments, baseline strain values at both global LV and territorial LAD segments. Control group showed mean territorial LAD strain was - 20.41± 0.61, mean baseline territorial LAD strain of group (A) - 13.20 ± 2.05 and mean baseline territorial LAD strain of group (B) - 8.47 ± 2.12. Regarding mean baseline territorial LAD strain and mean GLS of the LV, Receiver Operating Characteristic curve was done between group A and B for obtaining a cut off value of – 11.3 % and – 11.8 % respectively. Conclusion: LV global and territorial strain measured by 2D STE is a good predictor of LV function recovery in STEMI patients after percutaneous revascularization of infarct–related artery.