The use of myocardial global longitudinal strain to evaluate the effectiveness of reperfusion in acute myocardial infarction
Abstract
Abstract Introduction Global longitudinal deformation is a good predictor of LV ejection fraction independence and shows areas of myocardial damage Purpose The purpose of this study was to evaluate global longitudinal strain (GLS) in groups of patients with acute myocardial infarction who received primary thrombolysis, primary percutaneous coronary intervention (PCI) and life-saving PCI. Methods The study included 200 patients with acute myocardial infarction. The patients were divided into 3 groups, depending on the method of reperfusion: primary thrombolysis (62 patients), primary PCI (106 patients) and life-saving PCI performed after unsuccessful thrombolysis (32 patients). All patients received standard therapy, which included acetylsalicylic acid, ticagrelor, enoxaparin, beta blockers and ACE inhibitors. The assessment of GLS was performed before reperfusion, on the 14th day after reperfusion and 6 months later. The modular values of GLS were compared. Results Baseline values did not differ significantly between the groups. On day 14 after reperfusion, a significant increase in GLS was observed in the first and second groups (primary thrombolysis and PCI, respectively) (10.9 ± 2.95 vs 12.7 ± 1.98, p = 0.00001; 11.8 ± 2.41 vs 13.1 ± 1.92, p = 0.00001), while in the third group (rescue PCI) the values increased slightly but not significantly (11.3 ± 1.63 vs 11.6 ± 1.95, p = 0.17). At 6 months after reperfusion, the values of GLS significantly increased in all three groups, with the best results in the primary PCI group: 15.9 ± 2.08 vs 14.8 ± 1.81 in the first group and 13.6 ± 2.07 in the third group (p = 0.01). Regarding clinical outcomes, no cases of early post-infarction angina or left ventricular aneurysm were observed in the primary PCI group, but this group had a higher incidence of mild to moderate chronic heart failure (10.38% vs 0% and 29.25% vs 6.45% and 34.8%, respectively, p = 0.01). Conclusion The conducted study in patients with acute myocardial infarction who underwent various methods of reperfusion therapy revealed significant differences in the dynamics of recovery of longitudinal deformation of the left ventricular myocardium. It has been established that the assessment of this parameter can serve as an additional diagnostic and prognostic criterion in this category of patients. The data obtained indicate the advantages of primary PCI over thrombolytic therapy and life-saving PCI in terms of restoring myocardial contractile function. Thus, early primary PCI should be considered as the preferred method of reperfusion therapy in acute myocardial infarction.