Page 174 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter nine. Summary, conclusions and future perspectives
time) and decreased LA reservoir strain (echocardiographic marker for LA compliance). Finally, these studies provide near normal values for the aforementioned speckle tracking echocardiography derived parameters.
Part II: Advanced echocardiography in patients with ischemic heart disease
The second part is focussed on the role of conventional and advanced echocardiography in patients with ischemic heart disease.
Little is known about the proportion of patients who exhibit full LV systolic functional recovery after ST-segment elevation myocardial infarction (STEMI). In Chapter 4 we observe that the prevalence of LVEF ≤40% is low (13%). With optimal guideline based medical therapy, LVEF normalizes in 39% of contemporary STEMI patients after 6 months. Smaller enzymatic infarct size, baseline LVEF and absence of mitral regurgitation were independently associated with LVEF recovery at follow-up.
Furthermore, LV remodelling has been associated with long-term clinical outcomes. Parameters such as LVEF have been associated with adverse remodelling however this parameters is limited. LV GLS has shown to be of incremental value for prediction of LV remodelling. Yet the role of layer-specific LV GLS remains uncertain. In particular reduced epicardial LV GLS may reflect the amount of infarct size. Since the endocardial orientated fibers are predominantly responsible for the longitudinal function and primarily affected in ischemic heart disease, the mid-myocardium and the epicardial layer predominantly contribute to thickening and to radial and circumferential function. These mid-myocardium and epicardial layers prevent further LV dilatation and thus preserve global LV systolic function since they reflect the extent of myocardial infarct size (Chapter 5)
In addition, layer-specific LV GLS could help in evaluating the prognosis. In patients with mildly reduced or preserved LVEF, aging and reduced LV GLS of the epicardial layer were independently associated with higher risk of all-cause mortality (Chapter 6). Reduced LV GLS at the epicardium shows significant incremental value for prediction of all-cause mortality. It is suggested that the layer-specific measurements of the endocardium more accurately discriminate non-infarcted areas from non-transmural infarct areas, whereas the epicardium better differentiates between non-transmural infarction and transmural infarcted areas.
Patient with ischemic heart disease are at increased risk of ventricular arrhythmias (VA). LV mechanical dispersion (MD) has been shown to be associated with VA and
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