title: Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging.
abstract: Assessment of left ventricular (LV) function is important for decision-making and risk stratification in patients with acute coronary syndrome. Many patients with non-ST segment elevation myocardial infarction (NSTEMI) have substantial infarction, but these patients often do not reveal clinical signs of instability, and they rarely fulfill criteria for acute revascularization therapy.
  
  
  OBJECTIVE
  This study evaluated the potential of strain Doppler echocardiography analysis for the assessment of LV infarct size when compared with standard two-dimensional echo and cardiac magnetic resonance (CMR) data.
  
  
  METHODS
  Thirty patients with NSTEMI were examined using echocardiography after hospitalization for 1.8 ± 1.1 days for the assessment of left ventricular ejection fraction, wall motion score index (WMSI), and LV global longitudinal strain (GLS). Infarct size was assessed using delayed enhancement CMR 6.97 ± 3.2 days after admission as a percentage of total myocardial volume.
  
  
  RESULTS
  GLS was performed in 30 patients, and 82.9% of the LV segments were accepted for GLS analysis. Comparisons between patients with a complete set of GLS and standard echo, GLS and CMR were performed. The linear relationship demonstrated moderately strong and significant associations between GLS and ejection fraction (EF) as determined using standard echo (r = 0.452, P = 0.012), WMSI (r = 0.462, P = 0.010), and the gold standard CMR-determined EF (r = 0.57, P < 0.001). Receiver operating characteristic curves were used to analyze the ability of GLS to evaluate infarct size. GLS was the best predictor of infarct size in a multivariate linear regression analysis (β = 1.51, P = 0.027). WMSI >1.125 and a GLS cutoff value of -11.29% identified patients with substantial infarction (≥12% of total myocardial volume measured using CMR) with accuracies of 76.7% and 80%, respectively. However, GLS remained the only independent predictor in a multivariate logistic regression analysis to identify an infarct size ≥12%.
  
  
  CONCLUSIONS
  GLS is a good predictor of infarct size in NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk NSTEMI patients.
authors.affiliation: Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Loutfi
authors.affiliation: Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Ashour
authors.affiliation: Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: El-Sharkawy
authors.affiliation: Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Sara
authors.initials: S
authors.lastname: El-Fawal
authors.affiliation: Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Karim
authors.initials: K
authors.lastname: El-Touny
keywords: MRI; NSTEMI; infarct size; strain rate