الفهرس 
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Abstract
Left ventricular remodeling following acute myocardial infarction is associated with increased cardiovascular events. It is associated with progressive LV dilation, rearrangement of wall structure, myocyte hypertrophy and increased muscle mass without affecting the wall thickness (Michael J. Bonios et al., 2014).
Acute myocardial infarction (AMI) with its accompanying adverse sequelae, remains one of the most common causes of morbidity and mortality in the world (Joseph B. Muhlestein, 2014).
Following acute myocardial infarction (AMI) the development
of left ventricular (LV) dilatation, caused by alterations in architecture and function of the left ventricle, is one of the most feared consequences of the complex process of ventricular remodeling. Ventricular remodeling involves both the infarcted and non infarcted zone, and is considered as one of the major determinants of poor outcome (John SM et al., 1994).
The aim of the study is the assessment of left ventricular remodeling after acute revascularization of patients with first attack of myocardial infarction by 2D speckle-tracking echocardiography.
The study was carried out during the period between October 2016 and November 2017; this study included 50 patients with anterior ST elevation myocardial infarction who are admitted to the CCU department in National Heart Institute.
The patients enrolled into 2 groups each one includes 25 patients: group A (n=25): 25 patients with anterior STEMI underwent Primary PCI, group B (n=25): 25 patients with anterior STEMI received thrombolytic therapy
All patients were subjected to the following:
Personal data collection and risk factors assay such as age, gender, presence or absence of hypertension, diabetes, smoking, dyslipidemia and family history of IHD.
Peri-ACS data as the type of MI, the duration of chest pain, the door to needle time.
Reperfusion strategy: group of the patients who was subjected to reperfusion therapy by mechanical reperfusion PCI with TIMI III flow, the other one was subjected to pharmacological reperfusion therapy.
Baseline transthoracic echocardiography:
The echocardiographic studies were performed on the 3rd day of hospitalization.
1. Ordinary basic transthoracic echocardiography study was done
from the parasternal long axis view; the following were obtained; left ventricular dimensions, septal and posterior wall thickening, aortic root dimension and also left atrial dimension. The left ventricular ejection fraction and fractional shortening will be calculated using M-Mode.
from the parasternal short axis view; resting Regional Wall Motion Abnormalities (RWMA) was assessed at the level of mitral valve tips and at the level of papillary muscles.
from the apical views; RWMA was assessed.
Wall motion score (WMS) was evaluated. Visual analysis of the contractile function of all the 17 segments will be interpreted according to the American Society of Echocardiography criteriausing a four-point score:(1) normal; (2) hypokinetic; (3) akinetic; or (4) dyskinetic. Then the wall motion score was calculated.
2. D Speckle tracking echocardiography study:
The study in all patients was done during first 72h after PCI. The following views will be taken for later analysis; apical 4 chamber view, apical 2 chamber view, apical long axis view, short axis view at the level of papillary muscle and short axis view at the level of mitral valve. In blinded post-processing, longitudinal and circumferential deformation will be assessed by speckle tracking, being measured. The peak systolic circumferential strain (SPCS) and strain rate (Sr) (SPCSr) for 16 segments protocol will be calculated from the short axis views.