Evaluation of myocardial perfusion and deformation in patients with acute myocardial infarction treated with primary angioplasty and stent placement

PURPOSE: To prospectively compare the usefulness of myocardial perfusion and deformation imaging for the prediction of functional recovery and left ventricular (LV) remodeling in patients with ST-elevation myocardial infarction (STEMI). METHODS: We prospectively examined 36 patients with reperfused STEMI, 12+ or -9 h after primary angioplasty and stent placement. LV function was reevaluated at 4-6 months of follow-up, to assess relative improvement of LV-ejection fraction (DeltaEF%) and increase in end-diastolic volume (DeltaEDV). RESULTS: During the follow-up period, 19 of 36 patients showed LV function improvement (DeltaEF%> or =10%), whereas 10 patients had LV remodeling (DeltaEDV> or =20%). Peak negative strain (epislon (peak)), peak negative strain rate (SRpeak), and myocardial blood flow (Axbeta) correlated with DeltaEF% (r=-0.55, -0.57, and 0.46, respectively, P<0.01 for all), and allowed for prediction of LV remodeling on an individual level (area under the curve of 0.85 for strain rate, 0.95 for strain, and 0.90 for regional blood flow, P<0.001 for all). The combined assessment of myocardial perfusion and deformation correctly predicted LV remodeling in four additional patients, compared with each technique separately. CONCLUSION: Contrast echocardiography, strain Doppler imaging, and possibly the combination of both are useful for the prediction of adverse LV remodeling and for the early risk stratification of patients with STEMI.