title: Value of two-dimensional longitudinal strains analysis to assess the impact of thrombus aspiration during primary percutaneous coronary intervention on left ventricular function: a speckle tracking imaging substudy of the EXPIRA trial.
abstract: BACKGROUND
  Thrombectomy during primary percutaneous coronary intervention (Th-PCI) improves myocardial reperfusion in the absence of significant changes, in the acute phase, in traditional two-dimensional (2D) echo indexes of left ventricular (LV) function. The aim of this study was to evaluate the potential of 2D speckle tracking echocardiography (2DSTE) analysis in assessing the efficacy of thrombectomy as compared to standard 2D echo and cardiac magnetic resonance (CMR) data.
  
  
  METHODS
  Two-dimensional speckle tracking echocardiography analysis was performed in 60 anterior ST-segment elevation myocardial infarction (STEMI) patients to assess global (GLS), segmental (SLS) and regional longitudinal strain (RLS). 2D echo and CMR were performed within 5 days after PCI. Patients were divided into 2 groups according to the different methods of reperfusion used: 28 pts Th-PCI and 32 pts standard PCI (S-PCI).
  
  
  RESULTS
  Baseline clinical and angiographic characteristics, 2D echo, and DE-CMR data before and after PCI were similar in the 2 groups, except for microvascular obstruction (MVO), significantly lower (P = 0.001) in Th-PCI group. Conversely, GLS was significantly higher in Th-PCI group (P < 0.001), and in particular in the subset of patients without MVO (P = 0.012). RLS was also significantly higher in Th-PCI group (P = 0.001). GLS significantly correlates with infarct size, (R = 0.47; P = 0.03) and MVO (R = 0.69, P = 0.001). Finally, SLS was significantly lower in the DE segments (P < 0.001).
  
  
  CONCLUSIONS
  Patients treated with Th-PCI had a more preserved microvascular integrity resulting in a better myocardial longitudinal deformation. 2DSTE analysis adds significant information on the efficacy of thrombus aspiration as compared to standard echocardiography and it is closely related to the extent of microvascular damage.
authors.affiliation: Department of Cardiology, "Sapienza" University, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Cimino
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.forename: Luigi
authors.initials: L
authors.lastname: Lucisano
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.forename: Valentina
authors.initials: V
authors.lastname: Petronilli
authors.forename: Francesco
authors.initials: F
authors.lastname: Cicogna
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
mesh_terms: D003326:Coronary Circulation; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: myocardial infarction; myocardial strain; strain rate imaging