الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The “gold standard” noninvasive technique for the reproducible quantification of LV size and function is cardiac magnetic resonance (CMR) imaging. However, CMR is expensive, not widely available, and cannot be used in patients treated for heart failure with implantable devices (Ola et al., 2018). The advances in 3D Echocardiography, have bridged the gap, offering highly accurate (compared to CMR) analysis of LV size and function at the bedside (Qi et al., 2007). The aim of this study was to detect left ventricular remodeling in acute ST-elevation myocardial infarction patients after PCI by 2D echo and 3D echo and to evaluate which more accurate in comparison with cardiac magnetic resonance imaging in short term. This prospective observational study conducted on 50 patients with Acute ST-elevation myocardial infarction undergoing PCI at cardiovascular department at Tanta University Hospital. All patients were investigated by 2D echo, 3D echo and CMR. The current study revealed the following results: • This study included 50 patients with age range from 35 to 80 years with mean age 60.28 years. Female represented 30% of patients • Concerning risk factors, 50% were diabetics, 40%, 60% and 60% had smoking, hypertension, and dyslipidemia respectively • Serum troponin ranged from 6 to 22 with median 10 pg/ml • On studying affected artery, 70%, 20% and 10% had LAD, LCX and RCA affected respectively • On studying agreement between 2D and 3D echocardiographic parameters, there was poor agreement between both devices concerning end diastolic volume, end systolic volume, end diastolic volume index, end systolic volume index and ejection fraction (Cronbach alpha for validity was 0.33, 0.616, 0.295, 0.377 and 0.508 respectively, ICC for them was 0.06, 0.22, 0.13, 0.13 and 0.674 respectively) • On studying agreement between CMR and 3D echocardiographic parameters, there was better agreement and good reliability between both devices concerning end diastolic volume, and end diastolic volume index, (Cronbach alpha for validity was 0.803, and 0.81 respectively, ICC for them was 0.76, and 0.81 respectively [good reliability]) • On studying agreement between CMR and 3D echocardiographic parameters, there was best agreement and good to excellent reliability between both devices concerning end systolic volume, and end systolic volume index (Cronbach alpha for validity was 0.906 and 0.9 respectively, ICC for them was 0.9, and 0.81 respectively) • There is best agreement and good reliability of both devices in assessing EF (Cronbach alpha 0.941 and ICC 0.88) • On studying agreement between CMR and 2D echocardiographic parameters, there was poor agreement and poor reliability between both devices concerning end diastolic volume, end diastolic volume index, end systolic volume index and ejection fraction (Cronbach alpha for validity was 0.083, 0.287, 0.445, and 0.06 respectively, ICC for them was 0.05, 0.11, 0.14 and 0.02 respectively) • While there was poor agreement and moderate reliability between both regrading end systolic volume (Cronbach alpha 0.618 and ICC 0.2) • On studying agreement between 2D and 3D echocardiographic parameters on follow up, there was poor agreement and poor reliability between both devices concerning end diastolic volume, end systolic volume, end diastolic volume index, end systolic volume index, and good reliability and agreement for ejection fraction (Cronbach alpha for validity was 0.457, 0.442, 0.67. 0.603 and 0.794 respectively, ICC for them was 0.16, 0.1. 0.25, 0.27 and 0.76 respectively) • There was statistically significant increase in EDV (from 89.2 ml to 111.98 ml), ESV (from 50.82 ml to 62 ml), EDVI (from 58 ml/m2 to 68.78 ml/m2), ESVI (from 32.98 ml/m2 to 42.6 ml/m2) and ejection fraction (from 49.62% to 47.22%) according to 2 D echo parameters • There was statistically significant increase in EDV (from 106.9 ml to 122.54 ml), ESV (from 62 ml to 72.84 ml), EDVI (from 66.3 ml/m2 to 76.42 ml/m2), ESVI (from 40.8 ml/m2 to 47.22 ml/m2) and ejection fraction (from 49.18% to 46.08%) according to 3 D echo parameters • Early left ventricular remodeling occurred in 30% of studied patients. • There was statistically non-significant relation between remodeling and either age or gender. Two thirds of patients with remodeling were males versus 71.4% of those with no remodeling • There was statistically significant relation between remodeling and diabetes. About 34% patients with no remodeling were diabetics versus 86.7% of those with remodeling. There is statistically non-significant relation between remodeling and either smoking, hypertension or dyslipidemia • There was statistically significant relation between remodeling and affected artery (All cases with remodling was LAD) • There was statistically significant relation between remodeling and serum troponin level which was significantly higher in patients who furtherly developed early remodeling • There was statistically non-significant relation between occurrence of early left ventricular remodeling and baseline 2D echo parameters (EDV, ESV, ESVI, EDVI were non-significantly higher in patients with remodeling) • There was statistically significant difference between both groups regarding baseline EF • There was statistically significant relation between occurrence of early left ventricular remodeling and baseline 3D echo parameters (EDV, ESV, ESVI, EDVI were significantly higher in patients with remodeling and they had significantly lower EF) • There was statistically significant relation between occurrence of early left ventricular remodeling and baseline 3D SI which was significantly higher in patients who developed early remodeling • There was statistically significant relation between occurrence of early left ventricular remodeling and baseline CMR (EDV, ESV, ESVI, EDVI were significantly higher in patients with remodeling and they had significantly lower EF) • There was statistically significant relation between occurrence of early left ventricular remodeling and 3D echo parameters after three months and CMR (EDV, ESV, ESVI, EDVI, SI were significantly higher in patients with remodeling and they had significantly lower EF) • The best cutoff of baseline 3D EHO SI in prediction of occurrence of early left ventricular remodeling is ≥0.345 with area under curve 0.938 (95% CI 0.841-1) with sensitivity 93.3% and specificity 97.1% • The best cutoff of baseline EDV in prediction of occurrence of early left ventricular remodeling is ≥108ml with area under curve 0.884 (95% CI 0.753-1) with sensitivity 86.7% and specificity 94.3% • The best cutoff of baseline 3D EF in prediction of occurrence of early left ventricular remodeling is ≤49.5% with area under curve 0.928 (95% CI 0.837 – 1) with sensitivity 93.3% and specificity 68.6%.