scholarly journals Evaluation of the Right Ventricle Function Conducted in Patients after Acute Myocardial Infarction, Using Threedimensional Echocardiography and Myocardial Strain Analysis. Summary of the Doctoral Thesis

2021 ◽  
Author(s):  
◽  
Žanna Pičkure ◽  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Longitudinal Strain ◽  
Myocardial Strain ◽  
St Elevation Myocardial Infarction ◽  
Right Ventricle Function ◽  
St Elevation ◽  
The Right ◽  
Ventricle Function

It is well known that dysfunction of the right ventricle in ST segment elevation myocardial infarction causes such complications as rhythm disturbances, cardiogenic shock and others. Its presence is an independent prognostic indicator of all-cause mortality, cardiovascular mortality and development of heart failure. However, in clinical practice still too little attention is paid to the evaluation of the right ventricle function, despite the new echocardiographic methods available, which are capable of providing an accurate diagnostics of the right ventricle disfunction. The purpose of this work is to evaluate changes in the systolic function of the right ventricle in patients with proven acute ST elevation myocardial infarction by threedimensional echocardiography and myocardial strain techniques, and to select the most informative echocardiographic parameters for the size and function of the right ventricle for use in everyday practice. Based on the data gained during this study, the algorithm for the evaluation of the right ventricle function in patients with acute ST elevation myocardial infarction will be developed. A healthy individuals control group and a group of patients with ST elevation myocardial infarction were formed within the study. Each participant was examined according to standart echocardiography protocol. In each case new echocardiographic right venricle function evaluation methods also were applied – a three-dimensional echocardiography with following right ventricle reconstruction, volume and ejection fraction determination, as well as myocardial longitudinal strain measurements. Based on these methods, by comparing the data to the control group results, it was possible to etermine the pathology threshold for the right ventricular ejection fraction and longitudinal strain to detect right ventricle disfunction in the case of acute myocardial infarction. Three-dimensional echocardiography and evaluation of myocardial strain are new, relatively simple, sufficiently sensitive and specific methods for the diagnosis of right ventricular dysfunction in patients with ST elevation myocardial infarction. The methods are to be introduced for use in everyday clinical practice along with the standard ehocardiography parameters, which also change in ST elevation myocardial infarction: fractional area change, tricuspid annular plane systolic excursion, and visual evaluation of segmental systolic function of the right ventricle. Among new parameters ejection fraction of the right ventricle and right ventricle free wall longitudinal strain have to be determined. When evaluating the right chamber, it should be remembered that its function deterioration can be observed in case of myocardial infarction of any localization.

scholarly journals Right Ventricle Involvement in Patients with Acute ST Elevation Myocardial Infarction: Is Echocardiography Good Enough in Diagnosing It?

2021 ◽  
Vol 75 (1) ◽  
pp. 25-31
Author(s):  
Žanna Pičkure ◽  
Artem Kalinin ◽  
Aivars Lejnieks
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Stemi Patient ◽  
St Elevation Myocardial Infarction ◽  
Acute Stemi ◽  
St Elevation

Abstract Right ventricle (RV) dysfunction in patients with ST elevation myocardial infarction (STEMI) is more common and important than previously considered. The aim of this study was to determine the incidence of RV involvement in acute STEMI by using advanced echocardiography (Echo) methods, such as RV longitudinal strain and three-dimensional (3D) ejection fraction, and to prove that RV involvement is not exclusive to right coronary artery damage in STEMI. The study group was formed of 73 patients aged 30 to 60 years with confirmed first-time acute STEMI and coronary angiography performed. Abnormality thresholds for standard and advanced Echo parameters in case of STEMI for predicted RV dysfunction were RV 3D ejection fraction < 49% and RV free wall longitudinal strain > –24.5 %. Using these abnormality thresholds it was possible to detect RV dysfunction in 60% of STEMI cases. The acquired results are close to the cardiac magnetic resonance data found in literature, which is the gold standard for determination of RV systolic function. RV involvement did not depend on the damaged coronary artery, as there was no association detected (p = 0.09); therefore, RV function should be assessed in every STEMI patient, and Echo is an effective method for this purpose.

4937Global longitudinal strain by feature tracking predicts adverse remodeling in ST-elevation myocardial infarction incremental to

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Reinstadler ◽  
M Reindl ◽  
C Tiller ◽  
M Holzknecht ◽  
A Mayr ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Primary Endpoint ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Myocardial Strain ◽  
Lv Remodeling ◽  
Adverse Remodeling ◽  
St Elevation ◽  
Lv Ejection Fraction

Abstract Objectives To evaluate the independent and incremental value of left ventricular (LV) strain assessed by cardiac magnetic resonance feature tracking (CMR-FT) for prediction of adverse LV remodeling following ST-elevation myocardial infarction (STEMI). Background The role of LV myocardial strain by CMR-FT for prediction of adverse remodeling after STEMI in comparison to LV ejection fraction and infarct severity is unclear. Methods STEMI patients treated with primary percutaneous coronary intervention within 24 hours after symptom onset were enrolled. CMR core laboratory analysis was performed to assess LV ejection fraction, infarct pathology and LV myocardial strain. The primary endpoint was adverse remodeling defined as ≥20% increase in LV end-diastolic volume from baseline to 4 months. Results From the 232 patients included, 38 (16.4%) reached the primary endpoint. Global longitudinal strain (GLS), global radial strain, and global circumferential strain were all predictive of adverse remodeling (p<0.01 for all), but among strain values only GLS was an independent predictor of adverse remodeling (hazard ratio: 1.36 [1.03–1.78]; p=0.028) after adjustment for strain parameters, ejection fraction and CMR markers of infarct severity. A GLS >-14% was associated with a 4-fold increase in risk for LV remodeling (hazard ratio: 4.16 [1.56–11.13]; p=0.005). Addition of GLS to a baseline model comprising ejection fraction, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.26 ([0.13–0.38]; p<0.001) and integrated discrimination improvement of 0.02 ([0.01–0.03]; p=0.006). Conclusions In STEMI survivors, determination of GLS using CMR-FT provides important prognostic information for the development of adverse remodeling that is incremental to LV ejection fraction and CMR markers of infarct severity.

scholarly journals Correlation between Myocardial Strain and Angiographic Severity of Coronary Artery Disease in Non-ST-Elevation Myocardial Infarction Patient

2020 ◽  
Vol 5 (03) ◽  
Author(s):  
Md. Al-Amin ◽  
Md. Mashiul Alam ◽  
Tanjima Parvin ◽  
Chaudhury Meshkat Ahmed ◽  
Md. Zainal Abedin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
St Elevation Myocardial Infarction ◽  
Gensini Score ◽  
St Elevation ◽  
Artery Disease

Background and objectives: Noninvasive assessment of coronary artery disease severity remains a clinical challenge. Myocardium subtended by obstructive coronary artery disease may show reduced left ventricular strain. The present study was intended to investigate whether this reduction of strain value correlates with increasing severity of coronary artery disease in Non-ST-Elevation Myocardial Infarction (NSTEMI) patients. Methods: This cross sectional study included 86 patients of NSTEMI. We assessed myocardial strain in global longitudinal strain (GLS) value using two dimensional speckle tracking echocardiography (2DSE). We performed coronary angiogram of the same patients and documented presence or absence of significant disease, number of affected vessels and Gensini score. Significant coronary artery was defined as ≥70% stenosis in any major coronary artery and or ≥50% stenosis in left main coronary artery. Results: Global longitudinal strain value was significantly lower in the significant coronary artery disease group (-13.5±3.4% vs. -19.01±2.3%) (p < 0.001). GLS declined proportionately with increasing severity of coronary artery disease defined by number of affected vessels (p < 0.001). Spearman’s rank correlation coefficient test between GLS value and Gensini score showed that the two variables maintained a linear but inverse relationship (ρ = 0.816, p < 0.001) that implies decreasing GLS is associated with increasing Gensini score. Multivariate logistic regression analysis found global longitudinal strain as an independent predictor of coronary artery disease. Conclusion: Myocardial strain assessed in global longitudinal strain value correlates with angiographic severity of coronary artery disease in patients with Non-ST-Elevation Myocardial Infarction.

Abstract 16538: Circulating Ketone Levels are Associated With Myocardial Infarct Size and Left Ventricular Function in Patients Presenting With St-Elevation Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marie Sophie L de Koning ◽  
B. D Westenbrink ◽  
Solmaz Assa ◽  
Dirk J van Veldhuisen ◽  
Robin P Dullaart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Infarct Size ◽  
Ventricular Function ◽  
Myocardial Infarct ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Infarct Size ◽  
St Elevation

Background: Circulating ketone bodies (KB) are increased in patients with heart failure, corresponding with increased utilization of KB as a cardiac fuel. Whether circulating KB are increased in patients presenting with ST-elevation myocardial infarction (STEMI) and whether this is associated with infarct size is unknown. Methods: KB were measured in 379 non-diabetic participants of the Glycometabolic Intervention as Adjunct to Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction (GIPS) III trial (Clinicaltrial.gov Identifier: NCT01217307). Non-fasting plasma concentrations of the KB beta-hydroxybutyrate, acetoacetate, acetone were measured at presentation, 24 hours and 4 months after STEMI presentation using nuclear magnetic resonance spectroscopy. Associations of circulating KB with myocardial infarct size and left ventricular ejection fraction (both detected with MRI at 4 months after STEMI) were determined using multivariable linear regression analyses. Results: Circulating KB were higher at baseline (total KB 520 [315-997](median [IQR], μmol/L), compared to 206 [174-246] at 24 hours and 166 [143-201] at 4 months ( P <0.001 for all)). KB at 24 hours were positively associated with enzymatic infarct size, HbA1C and beta-blocker use. KB at 24 hours were independently associated with MRI outcomes at 4 months. Higher KB was associated with larger myocardial infarct size (total KB: standardized β=0.17, 95%-confidence interval (CI) (0.04-0.31), P =0.012) and lower ejection fraction (standardized β=-0.15, 95%-CI (-0.29- -0.009), P =0.037). Conclusion: Circulating KB are increased in patients with STEMI and are independently associated with myocardial infarct size and left ventricular function after 4 months of follow-up. The increase in circulating KB may reflect maladaptive changes of myocardial metabolism during the acute phase.

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