Left atrial function assessed by left atrial strain in patients with left circumflex branch culprit acute myocardial infarction

Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease

Echocardiography represents a first level technique for the evaluation of coronary artery disease (CAD) which supports clinicians in the diagnostic and prognostic workup of these syndromes. However, visual estimation of wall motion abnormalities sometimes fails in detecting less clear or transient myocardial ischemia and in providing accurate differential diagnosis. Speckle tracking echocardiography (STE) is a widely available noninvasive tool that could easily and quickly provide additive information over basic echocardiography, since it is able to identify subtle myocardial damage and to localize ischemic territories in accordance to the coronary lesions, obtaining a clear visualization with a "polar map" useful for differential diagnosis and management. Therefore, it has increasingly been applied in acute and chronic coronary syndromes using rest and stress echocardiography, showing good results in terms of prediction of CAD, clinical outcome, left ventricular remodeling, presence, and quantification of new/residual ischemia. The aim of this review is to illustrate the current available evidence on STE usefulness for the assessment and follow-up of CAD, discussing the main findings on bidimensional and tridimensional strain parameters and their potential application in clinical practice.

Interaction Effect of Diabetes and Acute Myocardial Infarction on the Left Atrial Function as Evaluated by 2-D Speckle-Tracking Echocardiography

The aim of the study described here was to investigate, using 2-D speckle-tracking echocardiography, whether myocardial infarction (MI) leads to diminished left atrial function in diabetic patients by comparison with non-diabetic patients. A total of 310 consecutive patients were divided into four groups based on the presence or absence of diabetes mellitus (DM) and acute ST-elevation MI. In the adjusted analysis, systolic and early diastolic strain and strain rate were reduced in the diabetic patients. Additionally, all deformation markers were impaired in the patients with MI. The DM-MI interaction was not statistically significant. Although reservoir, conduit and contraction functions of the left atrium were reduced in the patients with MI, left atrial reservoir and conduit functions were decreased in the diabetic patients. The reduction in left atrial function caused by MI was similar for diabetic and non-diabetic patients. Thus, DM and MI additively damaged left atrial function.

Evaluation of right atrial volumes and functions by real-time three-dimensional echocardiography in patients after acute inferior myocardial infarction

BACKGROUND

Right ventricle (RV) involvement causes acute systolic and diastolic functional alterations in the RV in patients after inferior myocardial infarction (IMI), which may result in an increase in left ventricle (LV) end-diastolic and right atrial (RA) pressure. In our study, we sought to evaluate RA volumes and mechanical functions using real-time three-dimensional echocardiography (RT3DE) in IMI patients with or without RV involvement.

METHODS

Ninety-six consecutive patients with IMI (mean age: 59.7 ± 10.2 years, 60 female) were included. RV myocardial involvement (RVMI) was defined as the presence of a culprit lesion at the proximal portion of the first RV marginal branch in coronary angiography. The study population was divided into two groups: IMI (58.3%) and IMI + RVMI (41.7%). Patients were evaluated using conventional two-dimensional echocardiography (2DE) and RT3DE.

RESULTS

In RT3DE measurements, IMI + RVMI patients had significantly higher RA phasic volumes and worse conduit mechanical function. A receiver operating characteristic (ROC) curve analysis revealed that an RT3DE RA maximum volume (Vmax) index > 27.9 mL/m² was an independent predictor of RV involvement in patients after acute IMI, with a sensitivity of 80.0% and a specificity of 89.3%.

CONCLUSIONS

Right ventricle involvement may cause an increase in RA phasic volumes and deterioration of conduit function in patients with acute IMI.