الفهرس 
ACKNOWLEDGMENTOnly 14 pages are availabe for public view
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Abstract
The cross-sectional design and the relatively small sample size were limitations of our study. Exclusion of high-risk STEMI patients might have affected our results. Baseline echocardiography was done within 24-72hrs following reperfusion therapy, where myocardial stunning might have affected the initial echo results. However, this was equally done for all patients, as it was not feasible both clinically and logistically to perform a detailed baseline 2D- and 3D-echo before reperfusion therapy in either group. The use of 3D-GLS (not available with every software package) would have been even more accurate relating it to the 3D LV volumes and remodeling indices. However, 2D-GLS images were acquired in the same setting as the 3D-volumetric images, using the same vendor and analyzed later offline with the same software. Manual input for echo-derived measurements is usually unavoidable and hence the chance of intra- and inter-observer variability. However, intra-observer variability was avoided by properly training the examiner before starting the analysis to be consistent throughout the measurements. Baseline and follow-up measurements were performed independently with the same observer, thus eliminating interobserver variability. LV reverse remodeling assessed by 3DE was more evident among PPCI-group compared to SK-group, despite attaining early successful reperfusion in both, but still with comparable proportions of those developing adverse remodeling. LV reverse remodeling was associated with significantly improved 2D GLS, which was not the case in those with adverse remodeling and was less evident among those with minimal LV geometric changesLarger sample size with more focus on the possible angiographic predictors of reverse remodeling among those undergoing PPCI in specific is recommended. It would be more important delivering improved patient-individualized optimal management (procedural and pharmacological) for those undergoing PPCI with the aim to attain reverse remodeling rather than just preventing development of adverse remodeling. Acute ST-segment elevation myocardial elevation (STEMI) is associated with left ventricular (LV) structural and hence functional consequences. The degree of ventricular remodeling changes in response to the incident infarction and reperfusion therapy offered may differ, which in turn might have functional and clinical long-term impact. AimThe study aimed to accurately define LV geometric changes using 3D-echocardiography (3DE) among STEMI patients undergoing reperfusion therapy with either primary percutaneous coronary intervention (PPCI) or streptokinase (SK). The study also aimed to define possible correlates of such LV geometric changes. MethodsThe study included 87 patients with STEMI, 54(62.1%) underwent PPCI and 33(37.9%) received SK. They underwent detailed 2D- and 3D-echocardiographic examination within 24-72hrs following the incident infarction and then at 6-month follow-up. Measured parameters included 2D LV dimensions, biplane volumes, wall motion assessment, Doppler data and 2D-speckle tracking (STE) to evaluate LV global longitudinal strain (GLS), as well as 3D-LV volumes, sphericity index (SI) and systolic dyssynchrony index (SDI). LV geometric changes were classified as; adverse remodeling (≥15% increased LV EDV at follow-up), reverse remodeling (≤15% deceased LV ESV at follow-up) and those with minimal LV volumetric changes not fitting in either reverse or adverse remodeling ones. Reperfusion and remodeling groups were also evaluated for occurrence of inhospital and follow-up major cardiovascular adverse events (MACE). ResultsThe incidence of those developing adverse remodeling was 25.4% while that of reverse remodeling was 36.6%, with reverse remodeling occurring more frequently among the PPCI-group. Adverse remodeling was associated with significantly higher inhospital and follow-up MACE with significantly lower use of beta blockers. Reverse remodeling was associated with significantly improved GLS, that was less evident in those with minimal LV geometric changes and very subtle in those with adverse remodeling. Subgroup analysis confined to patients with adverse or reverse remodeling showed moderate-strong correlation between GLS and ESV. This indicates a significant association between both functional GLS and structural 3D-volumes. ConclusionPPCI was associated with better LV remodeling and improved 2D GLS compared thrombolytic therapy, which was reflected on hard clinical endpoints. There was a significant association between functional GLS and structural 3D volumes.