P966Clinical application of speckle tracking echocardiography for assessing of infarct size early after reperfusion in patients with acute myocardial infarction


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Abstract

Aims: To investigate the ability of speckle tracking echocardiography (STE),using vector velocity imaging technique (VVI) to determinate the infarct size 24 hours after early primary percutaneous coronary angioplasty(PCI)in patients with acute myocardial infarction (AMI). The results were compared with intracoronary electrocardiography records (i.c. ECG), as a sensitive method for ischemia detection.Methods:20 normal volunteers (mean age 31y±5) and 30 patients (mean age 63±13) with AMI in the first 24 hours after PCI, were enrolled in this study.Standard echocardiography was performed and gray scale (frame rate- 65±7 frames/s)images were acquired in apical 4-, 2- and 3-chamber view and in short axis view at basal, middle and apical levels.The strain curves([Latin Small Letter Open E]LL, [Latin Small Letter Open E]CC, [Latin Small Letter Open E]RR)were extracted and derived using comersial VVI software(Syngo) in 18 segments LV model in infarct,perinfarct and remote regions.The i.c. ECG was performed during PCI, placing the coronary guidewire tip in all branches >1.5mm, making a “map” of residual ischemic region expressed in same 18segment model. ST-segment resolution less than 70% on icECG was accepted as a marker of necrosis.Results: After infarct, adverse remodeling (progressive increase in LV size, mass and reduced EF) was found. The radial and circumferential strain decreased in the infarct, perinfarct and remote regions acutely (Tabl.1) in comparison with controls. The reduction was lower for all types of strain ([Latin Small Letter Open E]LL, [Latin Small Letter Open E]CC, [Latin Small Letter Open E]RR). Longitudinal strain only was significantly decreased in infarct regions. There was a significant correlation between the infarct size (31,1±3,4%) and longitudinal strain (r=-0.49,p< 0.01), radial strain (r=-0.37,p<0,01) and circumferential strain(r=-0.39,p< 0.05) Conclusion: STE enables quantification of regional myocardial function in patients with AMI. The longitudinal strain measured early after reperfusion may predict infarct size and LV remodeling. The radial and circumferential strain in perinfarct and remote regions early after AMI may contribute to adverse left ventricular remodeling and progression to ischemic cardiomyopathy.

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