Role of Left Ventricular Twist and Torsion in Assessment of Reperfusion in Acute ST-Elevation Myocardial Infarction Patients

Background: Myocardial infarction is an acute emergency which needs rapid assessment, especially for myocardial reperfusion. Aim of the work: To evaluate left ventricle [LV] twist/torsion for assessment of myocardial reperfusion after acute ST-elevation myocardial infarction [STEMI] and to explore its relationship with LV function after 3 months. Patients and Methods:Forty-five patients with acute STEMI [30 anterior and 15 inferior] with a single culprit lesion were analyzed against 50 healthy subjects. Apical and basal rotations and LV twist/torsion were measured by two-dimensional speckle tracking imaging. Results: LV twist [13.5±2.4 vs 20±0.5] and LV torsion [1.8±0.2 vs 2.9±0.1, P=0.001] were reduced in all STEMI patients. Basal rotation was larger in anterior STEMI than in inferior STEMI and control [-8.09±0.7 vs -3.1±1.03 -6.2±0.6 successively], while apical rotation was significantly lower in anterior STEMI. LV twist and torsion were lower in anterior vs inferior STEMI [11.9±1.1 vs 16.6±1 and 1.7±0.1 vs 2.1±0.1, P=0.001 respectively]. There was moderate positive correlation between baseline LV torsion and LV ejection fraction at 3 months [r=0.500, P=0.001], while negative moderate correlation between baseline LV torsion and LV volumes [LV end-diastolic volume & LV end-systolic volume] [r=-0.444 & r=-0.479 respectively] was reported. Post reperfusion, the best cut-off point of LV torsion predicting LV remodeling was 1.9 with sensitivity 81.3% and specificity 82.8% [AUC =0.85]. Conclusion: Global LV torsion was decreased in acute STEMI patients, soon after reperfusion it showed marked improvement in LV torsion/twist. LV torsion early after reperfusion can predict LV remodeling at 3 months follow up.