The Impact of Different Revascularization Strategies Implemented in Acute Myocardial Infarction on the Recovery of Left Ventricular Functional and Deformational Parameters
Hany H. Ebaid
Department of Cardiovascular Medicine, Faculty of Medicine, Benha University, Egypt.
El-Sayed Abd Al-Khalik Eldarky
Department of Cardiovascular Medicine, Faculty of Medicine, Benha University, Egypt.
Ali I. Atia
Department of Cardiovascular Medicine, Faculty of Medicine, Benha University, Egypt.
Sayed M. El-Sayed *
Department of Cardiovascular Medicine, Faculty of Medicine, Benha University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Despite well-established therapeutic techniques, such as direct revascularization through percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) remains a leading cause of mortality and morbidity.
Objectives: To determine if two-dimensional speckle tracking echocardiography (STE) deformation parameters and the early recovery of left ventricular (LV) functions are affected by the timing of PCI in AMI.
Methods: A total of 200 cases with newly-onset acute myocardial infarction (AMI) who had a baseline left ventricular ejection fraction (LVEF) higher than 35% and received effective therapy with percutaneous coronary intervention (PCI) were included in this investigation. Cases were categorized as either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Cases were grouped into four groups according to the time between presentation and PCI. Using standard echocardiography and two-dimensional (2D) STE, individuals were re-evaluated initially and three months later to find out if remodeling had taken place or if the LV function had returned.
Results: Of the 200 AMI patients, including 140 males (70%), improvement in global longitudinal strain (GLS) and harmed longitudinal strain (HLS) were better in STEMI and NSTEMI patients received urgent revascularization with PCI (groups I and III) versus patients with pharmacoinvasive strategy or routine invasive strategy (Groups II and IV) (P < 0.05) while there was an insignificant difference between group I and III (P = 0.79). Of the 200 patients, 47 patients (23.5%) presented signs of LV remodeling at 3 months follow up. Age, smoking history, hypertension, dyslipidemia, Killip class, peak creatine phosphokinase - MB level, baseline left ventricular end diastolic volume (LVEDV), HLS, and harmed longitudinal strain rate (HLSR) were all factors that were found to be significantly associated with left ventricular remodeling (P<0.05) in the univariate logistic regression analysis. The following factors were identified as independent predictors of left ventricular remodeling in multivariate logistic regression analysis: damaged left ventricular ejection fraction (EF) and end-systolic volume, peak troponin I, Killip class, culprit left anterior descending (LAD), 2 and 3-vessel coronary artery disease (CAD), and wall motion score index (WMSI).
Conclusion: Earlier PCI in AMI helps earlier improvement in myocardial strain parameters. HLS and HLSR are excellent predictors for LV remodeling and may do better than global parameters.
Keywords: Speckle tracking echocardiography, LV remodeling, longitudinal strain, myocardial infarction, PCI, revascularization