title: Global longitudinal speckle-tracking strain is predictive of left ventricular remodeling after coronary angioplasty in patients with recent non-ST elevation myocardial infarction.
abstract: OBJECTIVE
  To test whether two-dimensional longitudinal strain (2DSE) performed after revascularization by percutaneous coronary intervention (PCI) could predict left ventricular (LV) remodeling in patients with recent non-ST elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  In 70 patients (62.7 ± 8.7 years) with recent NSTEMI (between 72 hours and 14 days), undergoing coronary angiography for recurrent angina, myocardial deformation parameters were measured by 2DSE before and 24 hours after reperfusion therapy. Strain in all LV segments was averaged to obtain a global value (Global longitudinal Strain--GLS). Infarct size was estimated by clinical parameters and cardiac markers. After 6 months from intervention, LV negative remodeling was defined as lack of improvement of LV function, with increase in LV end-diastolic volume of greater than or equal than 15%.
  
  
  RESULTS
  At follow-up, patients were subdivided into remodeled (n=32) and non-remodeled (n = 38) groups. Patients with negative LV remodeling had significantly lower baseline LV ejection fraction (44.8±6.9 vs. 48.7 ± 5.5 %; p < 0.05), higher peak troponin I (p < 0.001) and reduced GLS (- 10.6±6.1 vs - 17.6 ± 6.7 % p < 0.001) than those without LV remodeling. GLS showed a close correlation with peak troponin I after PCI (r = 0.64, P < 0.0001) and LV WMSI (r = 0.42, p < 0.01). By multivariable analysis, diabetes mellitus (P < 0.005), peak of Troponin I after PCI (P < 0.0005), GLS at baseline (OR: 4.3; p < 0.0001), and lack of improvement of GLS soon after PCI (OR: 1.45, P < 0.01) were powerful independent predictors of negative LV remodelling at follow-up. In particular, a GLS ≤ 12 % showed a sensitivity and a specificity respectively of 84.8% and 87.8% to predict negative LV remodelling at follow-up.
  
  
  CONCLUSIONS
  in patients with recent NSTEMI, longitudinal LV global and regional speckle-tracking strain measurements are powerful independent predictors of LV remodeling after reperfusion therapy.
authors.affiliation: Chair of Cardiology - Second University of Naples, Italy. antonellodandrea@libero.it
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.forename: Rosangela
authors.initials: R
authors.lastname: Cocchia
authors.forename: Pio
authors.initials: P
authors.lastname: Caso
authors.forename: Lucia
authors.initials: L
authors.lastname: Riegler
authors.forename: Raffaella
authors.initials: R
authors.lastname: Scarafile
authors.forename: Gemma
authors.initials: G
authors.lastname: Salerno
authors.forename: Enrica
authors.initials: E
authors.lastname: Golia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.forename: Maurizio Cappelli
authors.initials: MC
authors.lastname: Bigazzi
authors.forename: Biagio
authors.initials: B
authors.lastname: Liccardo
authors.forename: Nicolino
authors.initials: N
authors.lastname: Esposito
authors.forename: Sergio
authors.initials: S
authors.lastname: Cuomo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*