Using longitudinal myocardial deformation to assess the effectiveness of reperfusion in acute coronary syndrome

• Atamuratov B.R.
• Fozilov Kh.G.
• Fozilov K.G.
• Tursunova N.B.
• Abdullaeva S.Y.
• Yuldashov B.A.
• Doniyorov Sh.N.
• Valieva B.Sh.
• Usmonova N.A.
• Mukhamedova M.G.,

Abstract

The aim of this study was to assess myocardial longitudinal strain in patients with acute coronary syndrome who underwent primary thrombolysis, primary percutaneous coronary intervention (PCI), and rescue PCI.

Material and methods. The study included 200 patients with ST-elevation acute coronary syndrome. The patients were divided into three groups based on the method of reperfusion: primary thrombolysis (62 patients), primary PCI (106 patients), and rescue PCI performed after unsuccessful thrombolysis (32 patients).

Results. Baseline myocardial longitudinal strain values were not significantly different among the three groups, measuring 10.9±2.95 in the primary thrombolysis group, 11.8±2.41 in the PCI group, and 11.3±1.63 in the rescue PCI group. Immediately after reperfusion, there was a significant increase in myocardial longitudinal strain in the first and second groups (primary thrombolysis and PCI, respectively): ∆strain was 1.8 and 1.3, respectively, with p=0.00001. In the rescue PCI group, ∆strain was only 0.3, with p=0.17. Six months after reperfusion, there was further significant improvement in myocardial longitudinal strain in all three groups, reflecting continued enhancement of left ventricular contractile function. The highest longitudinal strain values were observed in the primary PCI group, significantly higher than those in the primary thrombolysis and rescue PCI groups. Although there was a statistically significant increase in longitudinal strain in the rescue PCI group, its values remained substantially lower compared to the other two groups.

Conclusions: For acute coronary syndrome with ST-segment elevation, primary PCI should be considered the preferred reperfusion strategy, as it provides the most complete recovery of myocardial contractile function in the long term. If primary PCI cannot be performed in an optimal timeframe, thrombolytic therapy may be considered as an alternative option.

Keywords: acute coronary syndrome; longitudinal strain of the left ventricle; reperfusion

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