title: Myocardial deformation and rotational mechanics in revascularized single vessel disease patients 2 years after ST-elevation myocardial infarction.
abstract: OBJECTIVE
  We sought to characterize the left ventricular strains and rotational mechanics in the infarct-related and remote regions of dilated heart following an ST-elevation myocardial infarction (STEMI) to understand the adaptive changes in global left ventricular function that develop several months after percutaneous coronary revascularization.
  
  
  METHODS
  Forty-six patients with STEMI (66.6 ± 11 years, 29 men) 2 years after coronary revascularization were enrolled. Longitudinal, circumferential, radial and rotational mechanics of the left ventricle were evaluated by speckle tracking echocardiography in 39 (84.8%) of them, after excluding seven patients with multivessel coronary disease. Forty-one asymptomatic volunteers without a history of coronary artery disease (65 ± 9 years, 23 men) served as controls.
  
  
  RESULTS
  There was no difference, between groups, regarding the prevalence of cardiovascular risk factors, whereas patients had significantly reduced left ventricular strains (P<0.001), rotations (P<0.001), twist (P<0.001), torsion (P<0.001) and untwisting rates (P<0001) in comparison with controls. Furthermore, reduction in regional strains was observed both in infarct and remote regions of the left ventricle and correlated with the changes in ejection fraction. On logistic regression analysis, only global circumferential strain was independently related (odds ratio 4.28; 95% confidence interval 1.11-16.4; P=0.034) with left ventricular dilation, defined as an indexed end-diastolic left ventricular volume more than 75 ml/m.
  
  
  CONCLUSIONS
  Reduction in regional strains and rotational mechanics are detectable in both the infarct-related and remote regions of dilated left ventricle. Attenuation of global circumferential strain, rather than isolated changes in the mechanics of the infarct region might contribute to determine the extent of left ventricular dilation, independent of the presence of multiple risk factors for left ventricular dysfunction. These findings might have important clinical implications regarding novel therapeutic approaches for counteracting left ventricular remodeling.
authors.affiliation: Cardiology Section, Department of Medicine and Pharmacology, University of Messina, Messina, Italy. tittizito@libero.it
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.forename: Caterina
authors.initials: C
authors.lastname: Longordo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caracciolo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lentini
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
mesh_terms: D000222:Adaptation, Physiological; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D007558:Italy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012399:Rotation; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling