Observational study of left ventricular global longitudinal strain in ST‐segment elevation myocardial infarction patients with extended pharmaco‐invasive strategy: A six months follow‐up study

Abstract

Aims and Objectives To evaluate left ventricular (LV) function by assessment of LV global longitudinal strain (GLS) in ST‐segment elevation myocardial infarction (STEMI) patients who underwent delayed fibrinolysis and coronary intervention (extended pharmaco‐invasive strategy), since LV function is one of the determinants of both immediate and long‐term outcomes. Methods Prospective study of consecutive STEMI patients who underwent extended pharmaco‐invasive strategy. The LV function was estimated using LV GLS at baseline and at 6 months. Results The study included eighty‐seven STEMI patients who received delayed pharmaco‐invasive therapy and coronary intervention. The primary aim of the study was to evaluate a change in LV function by assessment of GLS at 6 months as compared to baseline. Prior to PCI, LV ejection fraction was 48.08 ± 6.23% and GLS was −11.11 ± 2.99%. Procedural success was achieved in all patients. LV ejection fraction after 6 months of follow‐up increased to 53.12 ± 5.61% and the GLS improved to −13.03 ± 3.06% In comparison to baseline, there was a significant improvement in both LV ejection fraction and GLS at 6 months of follow‐up (P < .001).The cardiac mortality was 1.1% at 6 months. Conclusion There is a significant improvement of LV function as assessed by GLS and ejection fraction at short‐term follow‐up. In a stable cohort of STEMI patients, extended pharmaco‐invasive strategy is also a reasonable option if PCI cannot be performed within the first 24 hours, due to logistic and infrastructural constraints.

Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography

“…8 Manjunath et al showed that global longitudinal strain GLS estimated by speckle-tracking imaging provide more informative results when used. 9 They used SK in their work (88.5%) and resulted in preserved LVEF (53.12 ± 5.61) after a 6-month follow-up.…”

“…These results are in agreement with other published data. 8,9,17 According to guidelines 2 and other studies, 18 it is better to reperfuse the occluded artery by PI approach than waiting for PPCI. In Beni-Suef city, PPCI is not available in many centers.…”

Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention

“…The American Society of Echocardiography's guidelines were followed for taking LV measures. [ 17 , 18 ] Left atrial diameter (LAD), left ventricular end-diastolic and end-systolic diameters (LVDD and LVSD in mm), interventricular septum (IVS), posterior wall (PW) thickness at end-diastole, and left ventricular mass indexed to body surface area (LVMI) were all measured using M-Mode echo with 2-D guidance [ 17 , 18 ] We used Simpson's biplane approach to determine the LV ejection percentage (EF%). The pulsed-wave Doppler was used to record the mitral inflow velocities in order to quantify the following parameters: isovolumetric, E/A ratio, peak early (E) and late (A) diastolic velocities, and deceleration time of E velocity (DT) and isovolumetric relaxation time (IVRT).…”

“…The GLS average (GLS-Avg) was calculated from 17 myocardial segments, from the 3 longitudinal planes, (apical 4, 2 and 3 long axis views) i.e., vertically and basal, mid, and apical, i.e. horizontally of the anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral walls according to the current standards [ 18 – 20 ].…”

“…Every image under analysis was captured at a frame rate greater than 55 frames per second utilizing the Echo Pack system version 110.0.x (GE Medical System), and data were moved for offline analysis [ 19 ] Using the perfusion territories of the three major coronary arteries as a basis, a 17-segment left ventricular model's territorial longitudinal strain (TLS) was computed by averaging the segmental peak systolic strain values inside each territory [ 18 , 19 ].…”