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Objectives: To evaluate if global and regional longitudinal strain (LS) using two-dimensional speckle tracking echocardiography (2DSTE) could be useful to predict significant coronary artery disease (CAD) in patients with low risk acute coronary syndrome (ACS). We also assessed if LS is compensatory augmented in nonischemic segments and whether the gradient of LS between segments (LSD) would be higher in this category of patients. Methods: 117 consecutive patients presenting with low risk ACS, without wall motion abnormalities on conventional echocardiography underwent LS analysis by 2DSTE and coronary angiography. Global peak systolic longitudinal strain (GLS) of the 18 segments of left ventricle (LV), GLS of 12 segments of LV, LSD and longitudinal strain ratio (LSR), defined as the ratio of LSD to GLS were calculated. Territorial correlation between the segmental LS and angiography was also assessed. Results: GLS18 and GLS12 were significantly decreased, while LSD and LSR were increased in patients with CAD comparative with those without CAD. Moreover GLS18, GLS12, LSD and LSR had moderate predictive value for CAD (AUC 0.631, 0.67, 0.617 and 0.665 respectively). The regional predefined LS had moderate predictive value for left anterior descending artery disease (AUC=0.718) and right coronary artery disease (AUC=0.627), but not for circumflex disease (AUC=0,555). Conclusions: In low-risk ACS, global and regional LS could be a powerful noninvasive diagnostic tool for significant CAD. LSD and LSR are also valuable parameters, and together with standard strain parameters could improve the accuracy of rest echocardiography in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate if global and regional longitudinal strain (LS) using two-dimensional speckle tracking echocardiography (2DSTE) could be useful to predict signifi cant coronary artery disease (CAD) in patients with low risk acute coronary syndrome (ACS). We also assessed if LS is compensatory augmented in nonischemic segments and whether the gradient of LS between segments (LSD) would be higher in this category of patients. Methods: 117 consecutive patients presenting with low risk ACS, without wall motion abnormalities on conventional echocardiography underwent LS analysis by 2DSTE and coronary angiography. Global peak systolic longitudinal strain (GLS) of the 18 segments of left ventricle (LV), GLS of 12 segments of LV, LSD and longitudinal strain ratio (LSR), defi ned as the ratio of LSD to GLS were calculated. Territorial correlation between the segmental LS and angiography was also assessed. Results: GLS18 and GLS12 were signifi cantly decreased, while LSD and LSR were increased in patients with CAD comparative with those without CAD. Moreover GLS18, GLS12, LSD and LSR had moderate predictive value for CAD (AUC 0.631, 0.67, 0.617 and 0.665 respectively). The regional predefi ned LS had moderate predictive value for left anterior descending artery disease (AUC=0.718) and right coronary artery disease (AUC=0.627), but not for circumflex disease (AUC=0,555). Conclusions: In low-risk ACS, global and regional LS could be a powerful noninvasive diagnostic tool for signifi cant CAD. LSD and LSR are also valuable parameters, and together with standard strain parameters could improve the accuracy of rest echocardiography in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR. However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI. Methods and results: Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the first 7 days after a first ST elevation myocardial infarction (STEMI), and after 4 years of follow-up. The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33 cm, p<0.05), independently of the presence or severity of IMR. The posterior leaflet length and area got smaller over time (1.53±0.51 cm vs 1.27±0.33 cm; p<0.05 and 5.65±1.58 cm2 vs 4.88±1.65 cm2; p<0.05, respectively). The tenting height and area were smaller at follow-up (9.06±2.6 mm vs 7.84±2.61 mm, p<0.05; and 1.88±0.6 cm2 vs 1.57±0.5 cm2; p<0.05, respectively). A larger tenting at follow-up correlated with 3D left atrial (LA) volumes, but not with LV volumes and ejection fraction. Conclusions: MV geometry changes over time even in patients with non-severe IMR. The MV healing process consists in annulus flattening associated with improved tenting. [ABSTRACT FROM AUTHOR]