The Evaluation Of 3-dimensional Myocardial Motion Function By 2-dimensional Strain Deriving From Speckle-tracking Echocardiography In Patients With Acute Myocardial Infarction And Undergoing Percutaneous Coronary Intervention And The Correlation Between T

Objective To evaluate the regional and global 3-dimensional myocardial motion function by 2-dimensional strain derived from speckle-tracking echocardiography in patients with acute ST segment elevation myocardial infarction (STEMI); To investigate the changes of 3-dimensional myocardial motion function in patients with acute STEMI after percutaneous coronary intervention (PCI) by 2-dimensional strain; To investigate the correlation between the 2-dimensional strain and plasma NT-proBNP.Materials and Methods This study was admitted 32 consecutive patients who suffered from the first acute STEMI from September 2009 to March 2010,and 27 age-matched healthy volunteers as the control group. According to the culprit vessel,the patients were devided into left anterior descending branch(LAD)group(n=18),left circumflex branch(LCX) group(n=6),and right coronary artery(RCA) group(n=8); According to the left ventricular ejection fraction(LVEF), they were devided into normal group (LVEF≥55%), mild decrease group (40%≤LVEF< 55%), and moderate-severe decrease group (LVEF < 40%). The value of longitudinal,radial and circumferential strain (LS,RS,CS) of the regional myocardium and the global longitudinal,radial and circumferential strain (GLS,GRS,GCS) of the left ventricle were compared among each group.All the 32 acute STEMI patients underwent emergency PCI and were also finished follow-up in average 46.06±41.80days (3-106 days) According to the time of echocardiography examination after PCI, they were devided into post PCI-instantly group (2.39±2.06 hours), post PCI-1day group, post PCI-3 day group, post PCI-7 day group, post PCI-1month group (32.96±5.45days) and post PCI-3month group (94.24±9.14days).The value of GLS, GRS,GCS, LVEF and plasma NT-proBNP were compared among each group.Results Compared among each group, LS value reduced in 17 segments, CS value reduced in 12 segments and RS value reduced in 4 segments in LAD group, all of them reduced more significantly in anterior wall, septum, lateral wall and apical; LS value reduced in 5 segments, CS value reduced in 12 segments and RS value reduced in 3 segments in LCX group, all of them reduced more significantly in inferior posterior and lateral wall; LS value reduced in 10 segments,CS value reduced in 14 segments and RS reduced in 6 segments in RCA group, they all reduced more significantly in inferior posterior and lateral wall; all P<0.05.There were significant differences in GLS,GRS and GCS value among the acute STEMI patients with normal LVEF group, LVEF mild decrease group and LVEF moderate-severe decrease group(P< 0.05). Compared with the control group,GLS and GCS value reduced significantly, however, GRS value remained unchanged in the acute STEMI patients with normal LVEF group, (GLS:-21.00±1.76%VS-17.92±3.14%, GCS:-20.98±4.39%VS-16.62±2.97%, P< 0.05; GRS:36.33±17.79%VS 34.02±10.14%,P> 0.05).The correlation between GLS and LVEF was the strongest among the 2-dimensional strain(GLS:r=-0.80, GCS:r=-0.68, GRS:r=0.54; F=0.000). A cut off value of-14.79%for LS had a sensitivity of 89.10%and a specificity of 90.70%to identify the global myocardial function decrease.We found a upward trend in GLS,GRS,GCS and LVEF value in the acute STEMI patients within 3 months after emergency PCI. Compared with the post PCI-instantly group, GLS and GCS value both improved significantly in the post PCI-1 day, post PCI-3day, post PCI-1 month and post PCI-3 month groups (GLS:-11.36±6.01%VS-14.33±4.94%,-14.40±4.82%,-15.63±4.20%,-15.80±3.74%; GRS:23.47±8.33%VS28.56±9.96%,31.07±11.82%,32.33±7.43%,33.26±8.76%; P< 0.05), however, LVEF and GCS value improved significantly only in the post PCI-1month and post PCI-3month group(LVEF:51.10±6.92%VS 55.10±6.60%, 56.58±8.70%; GCS:-13.46±2.97%VS-16.16±3.32%,-17.09±3.07%; P< 0.05).We found that logNT-proBNP value increased to the peak value in the first day after emergency PCI, and then it declined gradually. The correlations between the GLS,GCS,GRS and logNT-proBNP were r=0.43, r-0.42, r=-0.26; P=0.000. There was no correlation between the logNT-proBNP value in the post PCI-instantly group and GLS value in the post PCI-lmonth group (r=-0.33 P=0.218), but, there were significant correlation between the logNT-proBNP value in the post PCI-1 day and post PCI-7day groups and GLS value in the post PCI-lmonth group (r=0.63, P=0.003;r=0.67, P=0.002)Conclusion:The changes of 3-dimensional myocardial motion function were various in patients with acute STEMI. The injuries of longitudinal and circumferential myocardial motion function were more serious than which of radial myocardial motion function.LS and CS value may be more accurate than RS value in location of myocardial infarction segments.2-dimensional strain may distinguish the global myocardial function in varying degrees, but, GLS and GCS value may be more sensitive than GRS value in evaluation of the slight decrease of global myocardial function. the longitudinal and radial myocardial motion function improved earlier than circumferential myocardial motion function, further more, GLS and GRSmay distinguish the improvement of myocardial function earlier than LVEF after PCI,. The correlation between 2-dimensional strain and plasma logNT-proBNP were significant in patients with acute STEMI after PCI, The level of logNT-proBNP on the first and seventh day may predict the inprovment of GLS in the first month after PCI.