الفهرس 
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Abstract
Evidence of residual myocardial viability in patients with ischemic left ventricular (LV) dysfunction has important therapeutic and prognostic implications. The benefit of revascularization for functional recovery depends on the presence of viable myocardial tissue. Analysis of functional, cellular, or metabolic integrity has been used for assessment of myocardial viability and prediction of functional recovery after revascularization in patients with chronic myocardial infarction. Contrast-enhanced cardiac magnetic resonance imaging (CMRI) has evolved into the noninvasive reference technique for the analysis of myocardial viability in chronic ischemic heart disease. It has been shown to have a high accuracy in the identification of reversible myocardial dysfunction before percutaneous or surgical revascularization. Ultrasonic myocardial deformation imaging using either tissue Doppler imaging or, more recently, frame-to-frame tracking of acoustic markers in 2-dimensional echocardiographic images has been shown in experimental as well as clinical studies to allow differentiation of different myocardial viability levels in chronic ischemic LV dysfunction. This study was conducted at Mansoura University Hospitals aiming to evaluate the ability of myocardial deformation analysis by two-dimensional (2D) STE obtained in the acute phase of STEMI for the prediction of global and segmental changes in LV function after AMI in comparison with Cardiac magnetic resonance CMR. We included a total of 35 subjects who were divided into three groups; group A included 10 cases who were managed by PCI, group B included 15 cases managed by fibrinolytic therapy (SK), and group C which included 10 healthy controls. All subjects were subjected to complete history taking, thorough physical examination, and routine laboratory investigations. Also, transthoracic echo, cardiac MRI, and speckle tracking echo were ordered for all subjects. Our results revealed that: • The mean age of the included subjects was 53.2, 51.47, and 54 years in the three groups, respectively with no significant difference between the three groups. • Although males were more predominant in the three groups compared to females,. • Diabetes was present in 20%and 33.3% of cases, while hypertension was reported by 80% and 53.3% of cases in Groups A and B respectively. • Smokers represented 70% and 46.7% of cases in the same groups, respectively. • hypercholesterolemia was detected in 20% and 60% of cases, whereas positive family history was reported by 20 and 26.7% of cases in Groups A and B, respectively. • As the control groups did not receive any regular medications, there was a significant difference between the three groups regarding all the studies drugs. Both aspirin and statins were commenced for 80% of cases in Groups A and B. other drugs included clopidogrel, ACEI/ARBs and B blockers. • Echocardiography revealed increased EDV and ESV in groups A and B compared to controls. Yet, the difference was statistically insignificant when it came to ESV. • MRI revealed a significant difference between the three groups regarding SWMA (p < 0.001). Apical SWMA occurred in 60 and 53.3% of cases, while anterior SWMA was detected in 60 and 53.3% of cases in Groups A and B, respectively. Besides, lateral SWMA occurred in 40 and 53.3%, whereas inferior SWMA occurred in 60 and 8.7% of cases in the same groups, respectively. Furthermore, septal SWMA was diagnosed in 80% and 73.3% of cases in the two cases groups, respectively. • There was a significant difference between the three study groups regarding the degree of myocardial enhancement. • There was a significant difference between the three groups regarding the affected coronary vessel. LAD was the commonest affected vessel in group A (50%), whereas RCA was the commonest affected artery in group B. • Speckle tracking showed a significant decrease in all strain parameters in cases compared to controls. Also, there was a significant difference between the three groups regarding SWMA. Both lateral and septal SWMA were detected in the three groups. The former was diagnosed in 90%, 73.3%, and 20% of subjects, while the latter was present in 80%, 66.7%, and 20% of subjects in the three groups, respectively. • The remaining three segmental SWMA were detected only in the cases groups. Apical SWMA was detected in 100% and 60% of cases while anterior SWMA was diagnosed in 90% and 60% of cases in Groups A and B respectively. In addition, inferior SWMA was detected in 80% and 60% of cases in the same groups, respectively. • When comparing MRI with speckle tracking findings, there was no significant difference between the two diagnostic modalities regarding SWMA apart from lateral SWMA that was over detected by speckle tracking compared to MRI. • There was a significant acceptable reliability for speckle tracking in the detection of SWMA. However, analysis regarding segmental types revealed poor or unaccepted reliability.