ABSTRACT
Introduction: Left ventricular remodeling is a relatively prevalent complication of acute myocardial infarction [AMI], and it is associated with higher rates of medical issues and mortality. Left ventricle ejection fraction [LVEF] and wall motion score index [WMSI] are unable to detect accurately minor lesions following AMI. Global longitudinal strain [GLS], which is obtained through 2D-speckle tracking echocardiography [2D-STE], provides an angle-dependent measurement by which the infarcted area can be assessed as a means of identifying potential dysfunction. The main objective of this study was to evaluate whether GLS could adequately predict LV remodeling in AMI patients
Methods: The MEDLINE database from database inception to May 6th, 2015, was searched for relevant keywords and the reference lists of systematic reviews and eligible studies were also screened. All studies involving patients with their first reported case of AMI were examined for GLS by 2D-STE and were evaluated for LV remodeling at a three-month follow-up point. Four English-language prospective cohort studies were eligible for inclusion in this study
Result: A total of 291 AMI patients [mean age=57.92 years] were investigated across four different studies. The main finding of this study was that the most reliable and consistent measurement for the purposes of predicting LV remodeling in AMI patients is GLS obtained at the time of discharge, especially in STEMI patients
Discussion: In addition to their poor reproducibility, inability to stratify risks, and inter-observer variability, compensatory hyperkinesis of intact myocytes and myocardial stunning after an AMI are among the main reasons why LVEF and WMSI may not be the most effective predictors of LV remodeling in AMI
Conclusion: GLS obtained by 2D-STE at the time of discharge could be used as a reliable predictor of LV remodeling in AMI patients
ABSTRACT
Administration of glycoprotein 2b/3a inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention [PPCI] for ST-segment elevation myocardial infarction [STEMI]. Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab [0.25 microg/kg] bolus or two boluses of intravenous Eptifibatide [0.180 microg/kg] each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution [STR], and post-procedural thrombolysis in myocardial infarction [TIMI] grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect [arrhythmia] and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.61]. The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI [micromol/L/hr], was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 [interquartile range [IQR], 3006.0 to 11112.0] versus 7,294 [IQR, 3795.5 to 11803.5]; p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.87]. No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI