Contemporary echocardiography in non-ST elevation myocardial Infarction

Abstract

BACKGROUND: Non-ST elevation myocardial infarction (NSTEMI) has only recently been included in the definition of acute myocardial infarction and literature is limited regarding the usefulness of echocardiography as a diagnostic tool in this setting. Since analysis of regional wall motion abnormalities (RWMAs) by standard echocardiography is highly reliant on observer experience, advanced modalities are suggested as possible complementary methods to perform quantitative RWMA assessment and observe underlying coronary artery disease (CAD); however, their utility has not been widely tested in a clinical setting. AIM: The aim of this thesis was to explore the usefulness of echocardiography for determining systolic and diastolic dysfunction post NSTEMI and compare the results to coronary angiography. The viability and accuracy of utilising the advanced echocardiography modalities of tissue velocity imaging and speckle tracking derived velocity, strain and strain rate as novel indices for quantifying regional dysfunction and determining underlying CAD was also explored. CONCLUSIONS: The role of echocardiography in NSTEMI provides important information concerning systolic and diastolic dysfunction. We found excellent correlation between coronary angiography, clinical parameters and echocardiographic parameters. In general, the advanced imaging modalities correlated with both the presence of regional dysfunction and underlying CAD, however, there was overlap and variation within the data sets. With further technical and clinical refinement, these modalities may be useful supplementary tests to quantitatively evaluate RWMAs and to determine underlying CAD.