title: Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion.
abstract: BACKGROUND
  Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).
  
  
  METHODS
  Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.
  
  
  RESULTS
  At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. -11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR- group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (-15.58 ±8.9% vs. -25.53 ±8.8%, p < 0.001; -15.02 ±5.6 vs. -19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (-8.7 ±5.8% vs. -13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR- group. According to ROC analysis, circumferential apical strain > -15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.
  
  
  CONCLUSIONS
  Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients' follow-up.
authors.affiliation: Department of Cardiology, Multidisciplinary Hospital, Jaworzno, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Liszka
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Haberka
authors.affiliation: 1 Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Tabor
authors.affiliation: Department of Cardiology, Multidisciplinary Hospital, Jaworzno, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Finik
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gąsior
keywords: acute coronary syndrome; coronary artery disease; echocardiography