الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
After acute STEMI and coronary artery revascularization, the injured myocardium may functionally recover or become irreversibly remodeled. 2D STE allows examination of the different LV segments. Additionally, GLS measured by STE has been recently reported to be an accurate predictor of LV size and remodeling in AMI. Similarly, LV systolic function is one of the best known predictors of outcome. LVEF is the commonest echocardiographic parameter used to measure LV function. However, it has its several limitations. Several studies have shown that 2D STE determination of GLS could be used to predict adverse cardiovascular events after STEMI.Biochemical markers are also having a major participation in prognosis of STEMI patients. NT-pro BNP is one of the novel markers that showed to be a potent predictor of adverse outcomes in acute coronary syndrome patients.Therefore, this study was designed to evaluate the prognostic value of NT-pro BNP and speckle tracking echocardiography using GLS in acute STEMI patients with LVEF of 40% or more and to assess the correlation between NT-pro BNP and GLS.It included eighty STEMI patients who had undergone reperfusion either by thrombolytic or primary PCI and 50 persons as a control group with matching demographic data. STEMI group were subjected to detailed history taking, complete physical examination and complete laboratory testing that includes complete chemical and hematological assessment including kidney function, lipid profile and troponin T. NT-Pro BNP levels were measured for patients and control groups. Complete conventional echocardiographic assessment of systolic and diastolic functions of left ventricle with STE to assess GLS of left ventricle. Patients were followed for 6 months for composite primary end point (including all cause mortality and heart failure hospitalization) and secondary end points (including cardiovascular mortality, heart failure hospitalization, reinfarction and reinfarction accompanied by heart failure).This study revealed global longitudinal strain and NT-pro BNP as strong predictors of adverse events. GLS with a cut off value of (≤-8%) was able to discriminate patients who reached composite primary end point from those who didn’t with (AUC=0.971, p value<0.001, CI= “0.940-1.001”, sensitivity= 90%, specificity=91.67%, PPV=78.3%, NPV=96.5%), similarly NT-pro BNP with cut off value of (>2318pg/ml) was able to discriminate patients who reached composite primary end point with (AUC=0.802, p value<0.001, CI= “0.685-0.920”, sensitivity= 80%, specificity=75%, PPV=51.6%, NPV=91.8%).Univariate analysis showed both NT-pro BNP and GLS as most significant predictors for composite primary end point, while multivariate analysis revealed that GLS is superior to NT-pro BNP in its prediction.