P483The impact of thrombus aspiration on left ventricular systolic function, evaluated by echocardiography in terms of global longitudinal strain and rotational mechanics in acute myocardial infarction.


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Abstract

Acute myocardial infarction with ST elevation (STEMI) patients treated by primary percutaneous coronary intervention (PCI) with or without thrombus aspiration (TA) were included in two distinct groups.We aimed to evaluate left ventricular (LV) function of these two groups at early phase of STEMI with speckle tracking echocardiography (2DSTE) in addition to the conventional echocardiography. 67 STEMI patients -36 of them treated with TA followed by stenting and others with stenting alone (SA)- were included in the study. In both groups ischemic periods were relatively brief (133±101 min vs. 127±100 min; p=0.81). TIMI flow, TIMI Frame Count (TFC) and ST segment resolution (STR) were assessed postprocedurally. Peak CK and CKMB levels were recorded. Echocardiographic images were obtained in the 72 hours of the procedure. Together with conventional LV systolic parameters, average global longitudinal peak strain (GLPSavg), apical rotation, basal rotation and torsion of LV were analysed offline. There was no statistically significant difference between two groups (TA and SA respectively) in terms of successful reperfusion when percentage of individuals STR was achieved (88.8% vs. 87.1%; p=0.55), securing TIMI 3 flow (91.7% vs. 90.4; p=0.85) and TFC (33.0±9.8 f/s vs. 33.2±9.2 f/s; p=0.95) were taken into account. Peak CK levels were significantly higher in TA group (2196±1915 mg/dL vs. 1189±1039 mg/dL; p=0.01), however peak CKMB levels only tended to be higher (220±185 mg/dL vs. 152±137 mg/dL; p=0.09). No statistically significant difference of echocardiographic measurements were observed between two groups. The whole echocardiographic data obtained for TA and SA groups respectively are as follows: LV end-systolic volume, 57±19 mL vs. 55±19 mL; p=0.75; LV ejection fraction (EF), 47.7±7.9% vs. 49.7±8.6%; p= 0.40; Wall Motion Score Index (WMSI), 1.25,[0.54] vs. 1.18,[1.33]; p=0.17; apical rotation 10.0±5.0° vs. 10.0±5.4°; p=0.99; basal rotation -6.0±3.1° vs. -5.1±2.6°; p=0.22; torsion 14.7±5.4° vs. 14.3±4.8°; p=0.73; and GLPSavg, -14.5±3.8% vs. -14.5±3.7%; p=0.95.Conclusion: Stenting alone and TA posed to achieve similar success rates when reperfusion parameters such as STR and TFC were compared. Under these circumstances as expected LV function assessed with visual (WMSI), volumetric (EF), strain (GLPSavg) and rotational methods revealed no significant difference between the groups. This finding was thought to be associated with early and successful intervention in both groups. It should not be neglected that echocardiographic data may diverge when remodeling process is completed in long term follow-up.

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