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Article Type

Original Study

Abstract

Objective: The aim of this study was to assess apical rotation in patients with anterior and inferior myocardial infarction (MI) by speckle-tracking echocardiography. Background: Left ventricular ejection fraction (LVEF) is the most widely used index of left ventricular (LV) systolic function. However, the development of wall-motion abnormalities after acute MI significantly decreases the accuracy of LVEF; further, calculation of LV volume by the biplane Simpson method is inaccurate, because it depends on geometric assumptions. Recently, two-dimensional speckle-tracking imaging has facilitated noninvasive measurement of LV strain and rotation. Patients and methods: The present study enrolled 54 patients with anterior or inferior MI, in addition to 20 healthy volunteers (matched for age and sex) as the control group. Basal and apical LV short-axis images were acquired for further off-line analysis. Using commercially available two-dimensional strain software, apical, basal rotation, and LV torsion were calculated. Results: Apical rotation was significantly reduced in the patient group compared with the control group (P < 0.001). Consequently, torsion degree (P < 0.001), torsion rate, and untwisting rate (P = 0.007) were significantly reduced. Conclusion: There was a significant correlation between ejection fraction and apex rotation (r = 0.466, P = 0.044), torsion degree (r = 0.499, P = 0.03), and untwisting rate (r = −0.543, P < 0.001). Correlation with basal rotation was nonsignificant, and thus measurement of apical rotation alone (rather than calculation of LV torsion) might provide a simple and accurate alternative for assessment of LV contractility. No difference was found between anterior and inferior MI as regards torsion (P = 0.870). Apical rotation and torsion were decreased in ST-elevation MI, and this was statistically significant in patients with LV dysfunction.

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