title: Apical rotation as an early indicator of left ventricular systolic dysfunction in acute anterior myocardial infarction: experimental study.
abstract: BACKGROUND
  The aim of this study was to determine whether left ventricular (LV) apical rotation assessed by speckle tracking echocardiography (STE) can predict global LV systolic dysfunction after acute anterior myocardial infarction (AMI).
  
  
  METHODS
  STE analysis was applied to LV short-axis images at the basal and apical levels in 21 open-chest pigs, before and after left anterior descending coronary artery ligation. LV radial and circumferential strain and strain rate, apical and basal rotation, and LV torsion were recorded.
  
  
  RESULTS
  LV apical rotation (3.68 ± 1.73° pre-AMI vs. 2.19 ± 1.64° post-AMI, p<0.009), peak systolic rotation rate, and radial and circumferential strain as well as strain rate decreased significantly 30 min postAMI. The LV global torsion decreased significantly. Strain and rotational changes of the LV apex were primarily correlated with ejection fraction (EF), but those of the LV base were not. EF had a significant correlation with the global LV twist (r=0.31, p<0.05). On multivariate linear regression analysis, fractional shortening of the long-axis (FSL) (b=0.58, p<0.001), rotation of the LV apex (b=0.32, p<0.006) and LV dp/dtmax (b=0.26, p<0.02) were independently related with EF. On analysis, of the receiver operating characteristic curve, the area under the curve for apical rotation was 0.765, p<0.006; the best cutoff value of 2.92° had sensitivity 80% and specificity 71% in predicting EF<40%.
  
  
  CONCLUSIONS
  Apical rotation assessed by STE is a potential noninvasive early indicator of global LV systolic dysfunction in AMI and has a satisfactory association with LVEF. Its assessment could be valuable in clinical and research cardiology.
authors.affiliation: Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece. stouman@otenet.gr
authors.forename: Savvas T
authors.initials: ST
authors.lastname: Toumanidis
authors.forename: Anna
authors.initials: A
authors.lastname: Kaladaridou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bramos
authors.forename: Elias
authors.initials: E
authors.lastname: Skaltsiotes
authors.forename: John N
authors.initials: JN
authors.lastname: Agrios
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Vasiladiotis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Pamboucas
authors.forename: George
authors.initials: G
authors.lastname: Kottis
authors.forename: Spyridon D
authors.initials: SD
authors.lastname: Moulopoulos
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D042241:Early Diagnosis; D015150:Echocardiography, Doppler / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D020521:Stroke; D013552:Swine; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016276:Ventricular Function / Q000502:physiology*