title: Apical rotation, a simplified index of left ventricular twist is independently linked to recovery after acute anterior myocardial infarction.
abstract: BACKGROUND
  It is unclear whether apical rotation (Ar), which in normal setting represents the dominant contributions to LV twist by comparison to basal rotation (Br), predicts viability in acute anterior myocardial infarction (AMI). Our objective was to test the usefulness of Ar as a simple index to predict LV recovery after AMI.
  
  
  METHODS
  Fourty-five consecutive patients (mean age 60±14 years, mean LVEF 44±7%) with first AMI treated successfully by primary angioplasty underwent prospectively a comprehensive transthoracic-Doppler echocardiography including analysis of Ar, Br, and LV twist by 2-dimensional speckle tracking, using a basal and apical short axis-views, within 24h after angioplasty and 3-6months later. Recovery was defined as: - the normalization of the wall motion of more than 50% of initial abnormal segments (R1) and; - absolute improvement of LVEF≥10% (R2).
  
  
  RESULTS
  A better correlation was found between Ar and LV twist at each stage of the disease than between Br and LV twist (acute phase, R=0.77 vs. R=0.35; follow-up, R=0.9 vs. R=0.3 [all, P<0.001 for Ar, and all, P≤0.05 for Br]). Furthermore, a better correlation was found between Ar and follow-up LVEF (R=0.57), wall motion score index (R=0.44), and global longitudinal strain (R=0.54) (all, P<0.001) than between LV twist and the same parameters (R=0.39; R=0.32; R=0.32 respectively, all P<0.05). (For Br, all, P=NS). Ar as well as LV twist were significantly associated with recovery (all, P<0.01) with an area under the curve (AUC) higher for the former than for the latter (R1, N=18: AUC-Ar=0.81 and AUC-LV twist=0.69, P=0.05; R2, N=19: AUC-Ar=0.82, AUC-LV twist=0.75, P=0.1). In multivariate analysis, Ar remained an independent predictor of recovery R1 and R2 instead of LV twist (all, P≤0.01). Using a ROC curve analysis, the best cut-off of Ar to predict recovery R2 was 6.5°, with Se=77% Sp=85%, P<0.001.
  
  
  CONCLUSIONS
  Apical rotation is an independent predictor of segmental and global LV recovery after anterior acute anterior myocardial infarction treated successfully by primary angioplasty.
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France. Electronic address: patrickmeimoun.md@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Meimoun
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: S
authors.initials: S
authors.lastname: Abouth
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: S
authors.initials: S
authors.lastname: Martis
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: H
authors.initials: H
authors.lastname: Zemir
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: F
authors.initials: F
authors.lastname: Elmkies
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: J
authors.initials: J
authors.lastname: Boulanger
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: G
authors.initials: G
authors.lastname: Ahmad
authors.affiliation: Cardiologie, centre hospitalier, 60200 Compiegne, France.
authors.forename: J
authors.initials: J
authors.lastname: Clerc