Impella Effects on Reverse Myocardial Remodeling in Anterior ST-Elevation Myocardial Infarction: Insights from a Comprehensive Analysis of Acute and Chronic MRI Findings

Impella Effects on Reverse Myocardial Remodeling in Anterior ST-Elevation Myocardial Infarction: Insights from a Comprehensive Analysis of Acute and Chronic MRI Findings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impella Effects on Reverse Myocardial Remodeling in Anterior ST-Elevation Myocardial Infarction: Insights from a Comprehensive Analysis of Acute and Chronic MRI Findings Daisuke Fukamachi, Akimasa Yamada, Kurara Takahashi, Ran Sumida, and 19 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4534491/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Late adverse myocardial remodeling after ST elevation myocardial infarction (STEMI) is strongly associated with cardiac death. Global Longitudinal strain (GLS) and circumferential diastolic strain rate (CDSR) derived cardiovascular magnetic resonance imaging (CMRI) is a powerful predictor of late myocardial remodeling. However, Impella’s effects on CMRI-based myocardial remodeling after STEMI is not fully understood. Methods We retrospectively compared the CMRI-derived strain and left ventricular ejection fraction (LVEF) in the acute (18 [ 14 – 22 ]) vs 14 [ 6 – 22 ] days, P = 0.43) and chronic phases (118 [102–242] vs 117 [101–202] days, P = 1.0) after broad anterior STEMI. Results Five patients received an Impella before percutaneous coronary intervention (PCI), and 7 were given intra-aortic balloon pumping (IABP). There were no significant differences in age (67 ± 10 vs. 63 ± 13, P = 0.53), peak creatine kinase levels (2595 [2069–12932] vs. 4372 [2941–5601] IU/L, P = 0.76), and LVEF at admission (51 ± 11 vs. 50 ± 9%, P = 1.0) between the two groups. The Impella group showed significantly better acute CMRI-derived LVEF (49 ± 10 vs. 36 ± 8%, P = 0.03) and CDSR (0.9 ± 0.2 vs. 0.5 ± 0.3 s⁻¹, P = 0.018) despite no significant difference in acute GLS between the two groups (-9.4 ± 2.2 vs. -8.7 ± 1.6%, P = 0.88). In the chronic phase, CMRI-derived LVEF and GLS were significantly higher in the Impella group (54 ± 9 vs. 39 ± 5%, P = 0.018; -9.9 ± 1.3 vs. -6.5 ± 2.2%, P = 0.01). Conclusions The Impella implantation leads to better LVEF and CDSR in the acute phase compared to IABP, and further to maintenance of both LVEF and GLS through the chronic phase. Unlike with IABP, LV unloading brought about by Impella, significantly contributed to the reverse remodeling process. Health sciences/Cardiology Health sciences/Diseases anterior ST-elevation myocardial infarction Impella cardiovascular magnetic resonance imaging Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In a real-world population with ST elevation myocardial infarction (STEMI), patient prognosis has improved over the last few decades [ 1 ]. However, STEMI with cardiogenic shock still carries a high mortality rate, even after reducing the door-to-balloon time (DTBT) [ 2 ]. Furthermore, heart failure associated with STEMI tends to increase due to the development of left ventricular (LV) remodeling, which worsens the prognosis [ 3 ]. Therefore, the intra-aortic balloon pump (IABP) or Impella is the commonly used for mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI), especially in cases of broad anterior wall STEMI, which is susceptible to heart failure due to unstable circulation. The Impella (Abiomed, Danvers, Massachusetts, USA) offers a promising alternative for percutaneous MCS, providing robust circulatory support. It comprises a miniaturized axial flow pump integrated into a pigtail catheter that pumps blood from the left ventricle into the ascending aorta, providing a cardiac output of 2.5 L/min (Impella 2.5) and up to 4.0 L/min (Impella CP). The use of the Impella results in left ventricular unloading by reducing both stroke work and myocardial oxygen consumption [ 4 ]. In patients with STEMI undergoing primary PCI and optimal pharmacotherapy, nearly half experience LV post-infarct remodeling [ 5 ]. Global longitudinal strain (GLS) assessed by echocardiography, a key indicator of cardiac function post-STEMI, directly correlates with prognosis and the risk of heart failure [ 6 ] GLS derived from cardiovascular magnetic resonance imaging (CMRI) also correlates with infarct size and is considered the most reliable predictor of heart failure-related hospitalizations [ 7 ]. Our previous work demonstrated the acute beneficial effects of Impella on CMRI-based global radial and circumferential peak strain (GRS and GCS) rather than GLS in STEMI patients as compared to those without Impella [ 8 ]. The circumferential diastolic strain rate (CDSR) on CMRI during the acute phase strongly correlates with STEMI prognosis and predicts cardiac remodeling [ 9 ]. A study suggests that Impella improves left ventricular ejection fraction (LVEF) two years after STEMI treatment [ 10 ]. However, detailed assessment of LV function from the acute to chronic phases with Impella use have not been reported. To further assess Impella's impact, we retrospectively compared strain parameters from acute and chronic CMRI in patients with anterior wall STEMI requiring mechanical circulatory support, including Impella and IABP. Methods Study population To investigate the impact of early Impella use prior to PCI on LV reverse remodeling compared to the IABP as assessed by CMRI, we retrospectively enrolled 12 consecutive patients with extensive anterior STEMI who were admitted to our hospital between January 2017 and October 2020. Inclusion criteria required patients to have undergone PCI for their initial anterior STEMI, followed by CMRI prior to discharge and during follow-up. All patients underwent PCI with either the Impella or IABP support. Exclusion criteria included claustrophobia, history of prior myocardial infarction, clinical frailty score exceeding 6, or renal failure, including dialysis patients. Patients with acute myocardial infarction (AMI) complicated by cardiopulmonary arrest and impaired consciousness were also excluded. In all cases, the culprit lesion was located in either the proximal left anterior descending artery (LAD) or the left main coronary artery. STEMI was universally defined as myocardial infarction characterized by ST-segment elevation in two or more leads. Specifically, in leads V2-3, ST-segment elevation was considered significant if it measured ≥ 2.0 mm for men over 40, ≥ 2.5 mm for men under 40, and ≥ 1.5 mm for women of any age, while the criteria for ST-segment rise was ≥ 1.0 mm. Refer to Fig. 1 for the study's participant selection flowchart. Out of 63 patients with extensive anterior STEMI, 13 were included in the study. All patients consented to the use of their data for research purposes through the informed concent of opt-out method. The study protocol was reviewed and approved by the Ethics Committee at Nihon University Itabashi Hospital (RK- 230509-5). Data Collection Patient characteristics and follow-up data were obtained retrospectively from our hospital records. Patient background at the time of PCI for ACS was anonymized and extracted, including information such as age, gender, body mass index (BMI), smoking history, comorbidities (hypertension, diabetes, dyslipidemia, or prior coronary disease), hemodynamic parameters (heart rate, systolic blood pressure, and diastolic blood pressure), laboratory tests (hemoglobin (Hb) concentration, lactate levels, creatine kinase (MaxCK) and estimated glomerular filtration rate [eGFR]), and transthoracic echocardiographic parameters (left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume [LVEDV], and left ventricular end-systolic volume [LVESV]) obtained at the time of the emergency coronary angiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at discharge were used for analysis. Cardiogenic shock is defined by the following three criteria: 1) SBP < 90 mm Hg with appropriate fluid resuscitation and clinical and laboratory evidence of end-organ damage, 2) Clinical signs may include cold extremities, oliguria, altered mental status, and a narrow pulse pressure, or 3) Laboratory findings may reveal metabolic acidosis, elevated serum lactate, and elevated serum creatinine [ 11 ]. MCS was implanted upon admission in cases of cardiogenic shock or if cardiogenic shock occurred during the procedure. Either Impella or IABP were implanted. Implantation of mechanical circulatory support and post-MI medical treatments The Impella is generally used in cases of cardiogenic shock during PCI for anterior STEMI. The choice between the Impella and the IABP is made at the physicians' discretion. In all cases, both the Impella and the IABP were inserted just before PCI. The Impella used either 2.5 or CP. After PCI, patients were transferred to the coronary care unit for intensive care. The IABP and the Impella were removed once the patients' heart failure conditions stabilized, following the initiation of β-blocker and RAS inhibitor treatments. Subsequently, patients were transferred to a general ward for cardiac rehabilitation, with careful adjustment of cardioprotective agents. CMRI was performed before hospital discharge, after tapering off all vasopressor agents, including dobutamine infusions. The Impella and IABP groups were retrospectively compared, and follow-up CMRI was performed during the chronic phase. Cardiac Magnetic Resonance Imaging All patients underwent CMRI before discharge and during the chronic phase. All images were acquired using a 1.5-T scanner (Ingenia; Philips Healthcare, Eindhoven, Netherlands) with retrospective electrocardiographic gating and a dS Torso coil. LV analysis was performed offline using commercially available software (cvi42, version 4.1.8, Circle Cardiovascular Imaging, Calgary, Canada). The CMRI protocol included standard steady-state free precession (SSFP) cine and late gadolinium enhancement (LGE) MRI. Standard SSFP cine images covered the entire LV using short-axis slices and 2-, 3-, and 4-chamber views with a temporal resolution of < 40 ms. Endo- and epicardial LV contours were manually drawn on short-axis cine images covering the mitral valve to the apex at end-diastole and end-systole to calculate end-diastolic and end-systolic volumes, stroke volume, and ejection fraction. LV mass was calculated as the sum of myocardial volumes, multiplied by the specific gravity (1.05 g/mL) of the myocardial tissue. Papillary muscles were excluded from the calculation of LV mass. For LV strain analysis, endo- and epicardial borders were semi-automatically drawn at end-diastole in short- and long-axis cines, excluding papillary muscles from the endocardial contour, and automatically propagated to all slices throughout the cardiac cycle. Short-axis cines were tracked to derive radial and circumferential strain, while 2-, 3-, and 4-chamber-view cines were tracked to derive longitudinal strain. Based on the 16-segment model, the software algorithm calculated 2D peak strains (longitudinal, radial, and circumferential) by averaging the corresponding peak values of the segments. In all analyses, strain was defined as the average of the peaks of the global, infarcted, and non-infarcted strain curves. Systolic strain rate (SR) was the average of the peaks of the global, infarcted, and non-infarcted SR curves during systole, and diastolic SR was the peak during diastole. LGE imaging was acquired using a T1-weighted inversion recovery gradient-echo sequence 15 minutes after contrast administration (0.15 mmol/kg; Gd-BTDO3A; Gadovist, Bayer Japan, Tokyo, Japan) in three long-axis slices (2-, 3-, and 4-chamber views) and a stack of short-axis slices completely encompassing the LV. The infarct size was quantified using the full-width at half-maximum method. This method estimated an intensity threshold from the remote myocardium, which is the midpoint between the mean intensity within the remote region and the maximum intensity within the affected tissue in the short-axis. The LV myocardium was divided into infarcted and non-infarcted areas. The division followed the segmental coronary artery distribution model outlined in the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines. The infarcted area was defined as the proximal LAD perfusion territory, which included segments 1–2, 7–8, and 13–16. The remaining LV myocardium was designated as the non-infarcted area [ 12 ]. Study assessments CMRI included measurements of LVEF, LVEDV, LVESV, and infarct size. Strain analysis involved longitudinal, radial, and circumferential peak systolic and diastolic SRs in the global, infarcted, and non-infarcted areas. Clinical events were also documented, including hospitalization due to heart failure, all-cause death, non-fatal MI, stroke, stent thrombosis, and major bleeding, as recorded in medical records. Statistical analysis Values are presented as mean ± standard deviation (SD), median and interquartile ranges, and number and percentages. Continuous variables between the groups were analyzed using the Mann-Whitney U-test. Differences in categorical variables were assessed using Fisher's exact test or the chi-squared test. All analyses were conducted using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA), with P < 0.05 considered statistically significant. Results Baseline Characteristics of the Impella and IABP Groups A total of 12 patients participated in the study (Fig. 1 ) : five in the Impella group (four with Impella 2.5 and one with Impella CP) and seven in the IABP group. All patients had anterior wall STEMI. There were no significant differences in age (67 ± 10 vs. 63 ± 13 years, p = 0.53) and male sex (80% vs 86%, p = 1.0) between the two groups. The BMI was significantly lower in the Impella group (21 ± 1.4 vs. 24 ± 1.5 kg/m², p = 0.01). There were no differences in current smoking, hypertension, diabetes mellitus, or dyslipidemia, heart rate, systolic blood pressure, diastolic blood pressure, or other hemodynamic variables between the two groups at the time of hospital admission. There was no difference in lactate levels at presentation (2.8 ± 1.7 vs. 2.2 ± 1.2 mmol/l, p = 0.66), renal function and Hb levels. Mechanical ventilation was used in one case in both groups. Echocardiography on admission showed no significant differences in LVEF, LVEDV, and LVESV (51 ± 11 vs. 50 ± 9%, p = 1.0, 107 ± 18 vs. 104 ± 28 ml, p = 0.76, 47 ± 17 vs. 46 ± 15 ml, p = 1.0). All patients had occlusion of the proximal part of the LAD, and all patients had TIMI 3 blood flow using a drug-eluting stent, which was completed without complications. There was no significant difference in maximum CK levels between the Impella and IABP groups (2595 [2069–12932] vs 4372 [2941–5601] IU/L, p = 0.76). There was no significant difference in the duration that the MCS was in place. There were no significant differences in the use of antiplatelet agents, renin-angiotensin system (RAS) inhibitors, beta-blockers, or statins at the time of discharge. There was no statistically significant difference in the time to CMRI between the Impella and IABP groups, in both the acute and chronic phases (18 [ 14 – 22 ] vs. 14 [ 6 – 22 ] days, p = 0.43; 118 [102–242] vs. 117 [101–202] days, p = 1.0) (Table 1 ). Table 1 Baseline characteristics between patients with IMPELLA and IABP Impella (n = 5, 2.5:4 CP:1) IABP (n = 7) P-Value Age, years 67 ± 10 63 ± 13 0.53 Male gender 4 (80) 7 (86) 1.0 BMI (m 2 /kg) 21 ± 1.4 24 ± 1.5 0.01 Hemodynamic variables on admission Heart rate (beats/min) 80 ± 14 82 ± 23 0.64 Systolic blood pressure (mmHg) 106 ± 24 122 ± 18 0.34 Diastolic blood pressure (mmHg) 80 ± 21 88 ± 22 0.76 History or comorbidities Current smoking 0 (0) 3 (43) 0.21 Hypertension 3 (60) 6 (86) 0.52 Diabetes Mellitus 0 (0) 3 (43) 0.21 Dyslipidaemia 5 (100) 5 (71) 0.47 Prior coronary disease 0 (0) 1 (14) 1.0 Blood values on admission Lactate (mmol/l) 2.8 ± 1.7 2.2 ± 1.2 0.66 Hb (mg/dl) 13 ± 1.7 15 ± 1.3 0.20 eGFR (mL/min/1.73m 2 ) 73 ± 7.4 66 ± 18 0.20 Blood values at discharge NT-proBNP at discharge (pg/ml) 560 [71,2184] 1662[854,2498] 0.15 Support device Mechanical ventilation 1 (20) 1 (14) 1.0 VA ECMO 0 (0) 0 (0) Anterior STEMI 5 (100) 7 (100) Infarct-related artery Left main stem 0 (0) 0 (0) Left anterior descending 5 (100) 7 (100) Multivessel disease 1 (20) 1 (14) 1.0 Stent placement Drug-eluting stent 5 (100) 7 (100) Initial TIMI flow 0 3 (60) 5 (71) 1.0 Final TIMI flow3 5 (100) 7 (100) Max CK (IU/L) 2595[2069–12932] 4372[2941–5601] 0.76 Max CK MB (IU/L) 284[156–936] 307[263–386] 1.0 Door to balloon time (min) 63 ± 10 65 ± 16 0.76 Echo parameter on admission LVEF (%) 51 ± 11 50 ± 9 1.0 LVEDV (ml) 107 ± 18 104 ± 28 0.76 LVESV (ml) 47 ± 17 46 ± 15 1.0 E (cm/sec) 71 ± 11 64 ± 19 0.15 A(cm/sec) 65 ± 17 69 ± 31 0.72 E/A 1.2 ± 0.7 1.1 ± 0.8 0.53 Duration of MCS support (days) 4 ± 2 3 ± 1 0.27 Medications at discharge DAPT 5 (100) 7 (100) RAS inhibitor 5 (100) 7 (100) Beta blocker 5 (100) 6 (86) 1.0 Statin 5 (100) 7 (100) Change of medication at chronic CMRI phase (%) 0 (0) 0 (0) 1.0 Days of coronary care unit (days) 6[ 5 – 7 ] 7[ 4 – 9 ] 0.43 Days of hospital admission (days) 23[20–28] 28 [19–34] 0.64 Days of CMRI after admission (days) 18 [ 14 – 22 ] 14[ 6 – 22 ] 0.43 Days of follow up CMRI after admission (days) 118[102–242] 117 [101–202] 1.0 Values are shown as the number (%), mean ± SD or median (interquartile ranges). STEMI, ST-elevation myocardial infarction; BMI, body mass index; Hb, haemoglobin; eGFR, estimated glomerular filtration rate; DAPT, dual antiplatelet therapy; CPA, cardiopulmonary arrest; IABP, intra-aortic balloon pumping; VA ECMO, veno-arterial extracorporeal membrane oxygenation; LVEDV, left ventricular end-diastole volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; NT-pro BNP, n-terminal pro brain natriuretic peptide; TIMI, thrombolysis in myocardial infarction; CK, creatinine kinase; DES, drug eluting stent; CMRI, cardiac magnetic resonance image; N.A., not applicable Acute CMRI Assessment Between the Impella and IABP Groups Regarding the acute CMRI assessment, the LVEF was notably higher in the Impella group (49 ± 10% vs. 36 ± 8%, p = 0.03), but the LVEDV, LVESV, and LGE showed no statistically significant differences between the two groups (141 ± 30 ml vs. 176 ± 46 ml, p = 0.20; 72 ± 23 ml vs. 112 ± 46 ml, p = 0.15; 26 ± 11% vs. 28 ± 13%, p = 0.84) (Fig. 2.3). The Impella group had numerically better GRS (24 ± 9% vs. 15 ± 7%, p = 0.11), GLS (-9.4 ± 2.2% vs. -8.7 ± 1.6%, p = 0.88), and GCS (-14 ± 4% vs. -10 ± 4%, p = 0.15), but all were not statistically significant compared to the IABP group. Systolic strain rate in radial, longitudinal, and circumferential parameters also showed a similar trend, but none were significant between the two groups (Table 2 ). However, the Impella group demonstrated a significant improvement in global radial diastolic strain rate (RDSR) and CDSR (-1.5 ± 0.3 vs. -0.7 ± 0.4 s⁻¹, p = 0.01; 0.9 ± 0.2 vs. 0.5 ± 0.3 s⁻¹, p = 0.018) (Table 2 ). Furthermore, the RDSR for in non-infarcted area (-2.1 ± 0.3 vs. -1.1 ± 0.4 s⁻¹, p = 0.003) and CDSRs for both infarcted area (0.7 ± 0.2 vs. 0.3 ± 0.4 s⁻¹, p = 0.048) and non-infarcted area (1.1 ± 0.1 vs. 0.7 ± 0.2 s⁻¹, p = 0.003) were significantly better in the Impella group than in the IABP group. Table 2 Acute and Chronic CMRI strain parameters between the patients with IMPELLA and IABP CMRI strain parameters Impella(Acute) (n = 5) IABP(Acute) (n = 7) P-Value Impella (Chronic) (n = 5) IABP (Chronic) (n = 7) P-Value LV Radial Global Peak Strain (%) 24 ± 9 15 ± 7 0.11 27 ± 8 18 ± 4 0.07 Systolic strain rate (1/s) 1.5 ± 0.8 1.0 ± 0.3 0.11 1.4 ± 0.4 1.0 ± 0.3 0.15 Diastolic strain rate (1/s) -1.5 ± 0.3 -0.7 ± 0.4 0.01 -1.1 ± 0.6 -0.4 ± 0.5 0.15 Infarcted area Peak Strain (%) 21 ± 10 13 ± 6 0.15 24 ± 11 15 ± 6 0.20 Systolic strain rate (1/s) 1.4 ± 0.8 0.8 ± 0.3 0.11 1.2 ± 0.6 0.7 ± 0.4 0.07 Diastolic strain rate (1/s) -1.1 ± 0.4 -0.5 ± 0.5 0.11 -1.0 ± 0.7 -0.4 ± 0.6 0.15 Non-Infarcted area Peak Strain (%) 29 ± 7 18 ± 8 0.07 31 ± 5 22 ± 6 0.018 Systolic strain rate (1/s) 1.7 ± 0.8 1.2 ± 0.3 0.27 1.6 ± 0.4 1.4 ± 0.3 0.53 Diastolic strain rate (1/s) -2.1 ± 0.3 -1.1 ± 0.4 0.003 -1.1 ± 0.8 -0.5 ± 0.6 0.20 LV Longitudinal Global Peak Strain (%) -9.4 ± 2.2 -8.7 ± 1.6 0.88 -9.9 ± 1.3 -6.5 ± 2.2 0.01 Systolic strain rate (1/s) -0.8 ± 0.2 -0.6 ± 0.3 0.20 -0.7 ± 0.3 -0.4 ± 0.5 0.34 Diastolic strain rate (1/s) 0.6 ± 0.2 0.5 ± 0.3 0.43 0.6 ± 0.3 0.4 ± 0.3 0.27 Infarcted area Peak Strain (%) -6.9 ± 2.4 -6.4 ± 4.0 1.0 -8.8 ± 2.8 -5.4 ± 2.5 0.07 Systolic strain rate (1/s) -0.6 ± 0.2 -0.4 ± 0.5 0.53 -0.5 ± 0.5 -0.2 ± 0.7 0.43 Diastolic strain rate (1/s) 0.3 ± 0.2 0.3 ± 0.2 1.0 0.5 ± 0.4 0.3 ± 0.3 0.64 Non-Infarcted area Peak Strain (%) -13 ± 3 -12 ± 2 0.76 -11 ± 3 -8 ± 6 0.15 Systolic strain rate (1/s) -1.0 ± 0.4 -0.8 ± 0.4 0.34 -0.9 ± 0.4 -0.7 ± 1.2 0.76 Diastolic strain rate (1/s) 1.1 ± 0.4 0.8 ± 0.3 0.20 0.9 ± 0.3 0.7 ± 0.6 0.20 LV Circumferential Global Peak Strain (%) -14 ± 4 -10 ± 4 0.15 -15 ± 4 -11 ± 2 0.15 Systolic strain rate (1/s) -0.9 ± 0.4 -0.7 ± 0.2 0.34 -0.9 ± 0.2 -0.7 ± 0.2 0.20 Diastolic strain rate (1/s) 0.9 ± 0.2 0.5 ± 0.3 0.018 0.6 ± 0.2 0.4 ± 0.4 0.43 Infarcted area Peak Strain (%) -13 ± 5 -9 ± 5 0.34 -13 ± 6 -10 ± 3 0.34 Systolic strain rate (1/s) -0.8 ± 0.4 -0.5 ± 0.3 0.43 -0.8 ± 0.3 -0.5 ± 0.4 0.27 Diastolic strain rate (1/s) 0.7 ± 0.2 0.3 ± 0.4 0.048 0.6 ± 0.2 0.4 ± 0.4 0.20 Non-Infarcted area Peak Strain (%) -17 ± 3 -12 ± 4 0.07 -17 ± 2 -14 ± 3 0.048 Systolic strain rate (1/s) -1.1 ± 0.5 -0.8 ± 0.2 0.43 -1.0 ± 0.2 -0.9 ± 0.2 0.64 Diastolic strain rate (1/s) 1.1 ± 0.1 0.7 ± 0.2 0.003 0.6 ± 0.3 0.5 ± 0.6 0.64 CMRI, cardiac magnetic resonance image; LV, left ventricular Chronic CMRI Assessment Between the Impella and IABP Groups Regarding the chronic CMRI assessment, the Impella group exhibited a notably higher LVEF (54 ± 9% vs. 39 ± 5%, P = 0.018) and smaller LVESV (65 ± 16 mL vs. 110 ± 38 mL, P = 0.03). However, there was no significant difference in LVEDV between the two groups (Fig. 2.3). A significant improvement in GLS was observed in the Impella group (-9.9 ± 1.3% vs. -6.5 ± 2.2%, P = 0.01), but GRS and GCS also showed numerically better results but did not exhibit significant differences between the two groups during the chronic phase (Table 2 ). This improvement was due to the lack of change in GLS from the acute to chronic phase in the Impella group, compared to a significant decrease in the IABP group (Fig. 4 ). All diastolic strain rates, including radial, circumferential, and longitudinal, were not significantly different between the two groups. Clinical Outcomes None of the 12 patients in the two groups experienced clinical events, including hospitalization due to heart failure, all-cause death, non-fatal MI, stroke, stent thrombosis, or major bleeding, by the time of their chronic CMRI. Discussion This study uncovered three significant findings. First, the LVEF was higher with Impella compared to IABP during the acute phase. Second, both global RDSR and CDSR as well as those in the non-infarcted area, were significantly better in the Impella group during the acute phase. Third, during the chronic phase, LVEF continued to be higher in the Impella group, and GLS was better preserved within the Impella group. 1. Clinical outcomes, and Recovery of LVEF and Diastolic Strain Rate in the Acute Phase Several studies comparing Impella and IABP have been published. Many of these studies indicate that in-hospital mortality and adverse clinical procedural outcomes are higher in the Impella group in acute myocardial infarction with cardiogenic shock (AMICS) [ 13 , 14 ]. The frequency of hemorrhagic complications is notably higher in the Impella group, with reports indicating that the 30-day mortality rate is similar for both IABP and Impella [ 15 ]. However, there are reports that Impella CP can be used before PCI in AMICS patients without cardiac arrest, with good results [ 16 ]. However, a meta-analysis of patients with AMICS who received Impella before and after PCI showed better survival at 30 days and 6 months pre-PCI compared to post-PCI Impella placement, with no adverse events [ 17 ]. Our study was a small, single-center comparison, and 30-day mortality was not observed in either group. Our CMRI data showed no significant difference between the two groups in LGE, despite the previously reported effect of Impella on infarct size reduction [ 8 ]. Additionally, GRS, GLS, and GCS showed a numerically better results, but none were statistically significant. Nevertheless, we found greater LVEF and better values of global RDSR and CDSR, particularily in the non-infarcted area, during the acute phase in the Impella group. A recent report demonstrated that the CDSR serve as an effective index to predict the long-term risk of major cardiac adverse events and cardiac remodeling in patients with AMI [ 18 ]. Therefore, our findings may support beneficial effects, even on early cardiac remodeling, by Impella. 2. Maintaining GLS and improving LVEF in the Chronic Phase with Impella The effectiveness of Impella in improving diastolic function, as indicated by RDSR and CDSR, in the acute phase, almost disappeared in the chronic phase. However, regarding LVEF in the chronic phase, the Impella group maintained a higher LVEF compared to the IABP group. Our follow-up is shorter (approximately 120 days after MI), but this aligns with a report showing that LVEF and LV diameter at 2 years improved with the use of Impella in patients with STEMI and other conditions [ 20 ]. Additionally, this study also demonstrated that GLS remained stable in the Impella group from the acute to the chronic period, surpassing the IABP group in chronic GLS values. While the exact mechanism behind the abolition of diastolic functions in the acute phase among the Impella group remains unclear, it may be attributed to the typical reduction in both systolic and diastolic functions seen after myocardial infarction, particularly in the chronic phase [ 19 ]. GLS is known to significantly impact myocardial damage, LVEF, and major adverse cardiac events [ 21 ]. Thus, the protective effect of Impella on diastolic function in both the global and non-infarcted areas during the acute phase may have patially contributed to maintaining GLS and further improving LVEF in the chronic phase, approximately 4 months after the STEMI onset. An RCT has demonstrated that Impella significantly reduced all-cause mortality at 6 months compared to the non-Impella group, including IABP [ 22 ]. Notably, no studies have yet demonstrated a positive impact of Impella on early and chronic cardiac remodeling proccess, making this a significant finding in our study. However, the number of patients in our study is quite limited, and we are currently awaiting the results of the STEMI-DTU Trial (NCT03947619) being conducted in the USA. Study Limitations First, our study's limitations include its retrospective design. Additionally, our data is the result of a single-center registry providing a limited number of patients with broad anterior STEMI. Fortunately, similar patient backgrounds were observed between the Impella and IABP groups, expect for BMI, but latent patient selection bias and/or treatment intervention method cannot be controlled for. This study focused on detailed CMR analysis in the acute and chronic phases after STEMI, so the difference in clinical event effects between the Impella group and IABP group cannot be assessed within this limited patient cohort. Conclusions This comprehensive MRI-based study demonstrated that implantation of Impella before PCI resulted in better LVEF and CDSR in the acute phase compared to IABP, and further led to the maintenance of both LVEF and GLS through the chronic phase. Unlike with IABP, the maintenance of GLS from the acute to chronic phase, brought about by Impella, significantly contributed to the reverse remodeling process. Abbreviations AMI acute myocardial infarction AMICS acute myocardial infarction with cardiogenic shock BMI body mass index CDSR circumferential diastolic strain rate CMRI cardiac magnetic resonance image DTBT door-to-balloon time eGFR estimated glomerular filtration rate GLS global longitudinal strain IABP intra-aortic balloon pumping LAD left anterior descending LGE late gadolinium enhancement LV left ventricular LVEDV left ventricular end-diastole volume LVEF left ventricular ejection fraction LVESV left ventricular end-systolic volume MCS Mechanical circulatory support,MI,myocardial infarction radial diastolic strain rate RAS Renin-angiotensin system RCT Randomised controlled trial RDSR SR strain rate SSFP standard steady-state free precession NT-proBNP N-terminal pro-brain natriuretic peptide PCI percutaneous coronary intervention SR systolic strain rate STEMI ST-elevation myocardial infarction Declarations Ethics approval and consent to participate : All procedures were performed according to the ethical standards of the institutional research committee, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study and its protocols were approved by the Institutional Review Board of Nihon University Itabashi Hospital (RK- 230509-5 ). Consent for publication : Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests : Dr. Okumura belongs to the endowed departments of Boston Scientific Japan, Abbott Medical Japan, Japan Lifeline, Medtronic Japan, and Nihon Kohden. The others have no competing interests. Funding : Not applicable. Authors’ contributions: AY had analyzed CMR data. All authors read and approved the final manuscript. Acknowledgments : I am sincerely grateful to Professor Atsushi Hirayama for giving me many wonderful lessons during the introduction period of Impella and for teaching me the importance of treatment of myocardial infarction at coronary care unit. References Fabris E, Boldrin C, Gregorio C, et al. The Prognostic impact of treatments evolution in STEMI. Int J Cardiol:131352, 2023. Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901–9. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke Statistics-2017 update: A report from the American Heart Association. Circulation. 2017;135:e146-603. Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic shock. Eur Heart J 2015;36:1223–30. van der Bijl P, Abou R, Goedemans L, et al. Left Ventricular Post-Infarct Remodeling: Implications for Systolic Function Improvement and Outcomes in the Modern Era. JACC Heart Fail 8(2):131–140, 2020. Tawfik W, El-Sherif A, Bendary A, Mahros M, Salem M. Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Echocardiography 37(4):570–577, 2020. Holzknecht M, Reindl M, Tiller C, et al. Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters. Clin Res Cardiol 110(10):1599–1611, 2021. Fukamachi D, Yamada A, Ohgaku A, et al. Protective effect of the Impella on the left ventricular function after acute broad anterior wall ST elevation myocardial infarctions with cardiogenic shock: cardiovascular magnetic resonance imaging strain analysis. BMC Cardiovasc Disord 22(1):201, 2022. Wei L, Dong JX, Jin LX, et al. Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction. Radiol Med, 2023 Chatzis G, Syntila S, Schuett H, et al. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 10(6), 2021. Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J 2019;40:2671–83. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60. Schrage B, Ibrahim K, Loehn T, et al. Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock. Circulation 139(10):1249–1258, 2019. Almarzooq ZI, Song Y, Dahabreh IJ, et al. Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock. JAMA Cardiol 8(8):744–754, 2023 Alushi B, Douedari A, Froehlig G, et al. Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock. Open Heart 6(1):e000987, 2019. Iannaccone M, Albani S, Giannini F, et al. Short term outcomes of Impella in cardiogenic shock: A review and meta-analysis of observational studies. Int J Cardiol 324:44–51, 2021. Miyashita S, Banlengchit R, Marbach JA, et al. Left Ventricular Unloading Before Percutaneous Coronary Intervention is Associated With Improved Survival in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 39:28–35, 2022. Wei L, Dong JX, Jin LX, et al. Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction. Radiol Med 2023. Azevedo CF, Amado LC, Kraitchman DL, et al. Persistent diastolic dysfunction despite complete systolic functional recovery after reperfused acute myocardial infarction demonstrated by tagged magnetic resonance imaging. Eur Heart J 2004;25:1419–27. Chatzis G, Syntila S, Schuett H, et al. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 10(6), 2021. Tawfik W, El-Sherif A, Bendary A, Mahros M, Salem M. Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Echocardiography 37(4):570–577, 2020. Moller JE, Engstrom T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024. Additional Declarations Competing interest reported. Dr. Okumura belongs to the endowed departments of Boston Scientific Japan, Abbott Medical Japan, Japan Lifeline, Medtronic Japan, and Nihon Kohden.The others have no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4534491","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":316297700,"identity":"85460ee4-8969-4446-89fe-45753f8d0d59","order_by":0,"name":"Daisuke 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yasuo","middleName":"","lastName":"Okumura","suffix":""}],"badges":[],"createdAt":"2024-06-05 13:36:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4534491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4534491/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59137936,"identity":"20482089-c67f-4341-ba0a-40c1c3856daf","added_by":"auto","created_at":"2024-06-26 19:03:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":101883,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the study entrants\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4534491/v1/ce4eb8e87292da1dce727d93.jpg"},{"id":59138703,"identity":"9a076d81-6b40-4997-bcfc-bae3adce3d4c","added_by":"auto","created_at":"2024-06-26 19:11:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82879,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of LVEF in acute and chronic phase, and acute LGE with CMRI between IMPELLA group and IABP group\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4534491/v1/7c005101957b5c74f0f8c1e3.jpg"},{"id":59137939,"identity":"93d3564d-ecac-4bb8-96d7-565aa55a96d1","added_by":"auto","created_at":"2024-06-26 19:03:36","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":103467,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of LVEDV and LVESV in acute and chronic phase with CMRI between IMPELLA and IABP groups\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4534491/v1/d76b7398e80e08588628e647.jpg"},{"id":59137938,"identity":"60abbf11-3871-4202-8984-731564283858","added_by":"auto","created_at":"2024-06-26 19:03:36","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":100551,"visible":true,"origin":"","legend":"\u003cp\u003eChanges of LVEDV and LVESV with CMRI from acute to chronic phases with CMRI between IMPELLA and IABP groups\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4534491/v1/892e7964a7282046b28bbccc.jpg"},{"id":67628258,"identity":"bdff69cc-438c-41ad-a363-24f7d8c95576","added_by":"auto","created_at":"2024-10-28 08:17:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1579042,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4534491/v1/d29eb2bd-c0e6-4c69-b330-7415361d1d0d.pdf"}],"financialInterests":"Competing interest reported. Dr. Okumura belongs to the endowed departments of Boston Scientific Japan, Abbott Medical Japan, Japan Lifeline, Medtronic Japan, and Nihon Kohden.The others have no competing interests.","formattedTitle":"Impella Effects on Reverse Myocardial Remodeling in Anterior ST-Elevation Myocardial Infarction: Insights from a Comprehensive Analysis of Acute and Chronic MRI Findings","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn a real-world population with ST elevation myocardial infarction (STEMI), patient prognosis has improved over the last few decades [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, STEMI with cardiogenic shock still carries a high mortality rate, even after reducing the door-to-balloon time (DTBT) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, heart failure associated with STEMI tends to increase due to the development of left ventricular (LV) remodeling, which worsens the prognosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, the intra-aortic balloon pump (IABP) or Impella is the commonly used for mechanical circulatory support (MCS) during percutaneous coronary intervention (PCI), especially in cases of broad anterior wall STEMI, which is susceptible to heart failure due to unstable circulation. The Impella (Abiomed, Danvers, Massachusetts, USA) offers a promising alternative for percutaneous MCS, providing robust circulatory support. It comprises a miniaturized axial flow pump integrated into a pigtail catheter that pumps blood from the left ventricle into the ascending aorta, providing a cardiac output of 2.5 L/min (Impella 2.5) and up to 4.0 L/min (Impella CP). The use of the Impella results in left ventricular unloading by reducing both stroke work and myocardial oxygen consumption [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn patients with STEMI undergoing primary PCI and optimal pharmacotherapy, nearly half experience LV post-infarct remodeling [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Global longitudinal strain (GLS) assessed by echocardiography, a key indicator of cardiac function post-STEMI, directly correlates with prognosis and the risk of heart failure [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] GLS derived from cardiovascular magnetic resonance imaging (CMRI) also correlates with infarct size and is considered the most reliable predictor of heart failure-related hospitalizations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Our previous work demonstrated the acute beneficial effects of Impella on CMRI-based global radial and circumferential peak strain (GRS and GCS) rather than GLS in STEMI patients as compared to those without Impella [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The circumferential diastolic strain rate (CDSR) on CMRI during the acute phase strongly correlates with STEMI prognosis and predicts cardiac remodeling [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A study suggests that Impella improves left ventricular ejection fraction (LVEF) two years after STEMI treatment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, detailed assessment of LV function from the acute to chronic phases with Impella use have not been reported. To further assess Impella's impact, we retrospectively compared strain parameters from acute and chronic CMRI in patients with anterior wall STEMI requiring mechanical circulatory support, including Impella and IABP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eTo investigate the impact of early Impella use prior to PCI on LV reverse remodeling compared to the IABP as assessed by CMRI, we retrospectively enrolled 12 consecutive patients with extensive anterior STEMI who were admitted to our hospital between January 2017 and October 2020. Inclusion criteria required patients to have undergone PCI for their initial anterior STEMI, followed by CMRI prior to discharge and during follow-up. All patients underwent PCI with either the Impella or IABP support. Exclusion criteria included claustrophobia, history of prior myocardial infarction, clinical frailty score exceeding 6, or renal failure, including dialysis patients. Patients with acute myocardial infarction (AMI) complicated by cardiopulmonary arrest and impaired consciousness were also excluded. In all cases, the culprit lesion was located in either the proximal left anterior descending artery (LAD) or the left main coronary artery. STEMI was universally defined as myocardial infarction characterized by ST-segment elevation in two or more leads. Specifically, in leads V2-3, ST-segment elevation was considered significant if it measured\u0026thinsp;\u0026ge;\u0026thinsp;2.0 mm for men over 40, \u0026ge;\u0026thinsp;2.5 mm for men under 40, and \u0026ge;\u0026thinsp;1.5 mm for women of any age, while the criteria for ST-segment rise was \u0026ge;\u0026thinsp;1.0 mm. Refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e for the study's participant selection flowchart. Out of 63 patients with extensive anterior STEMI, 13 were included in the study. All patients consented to the use of their data for research purposes through the informed concent of opt-out method. The study protocol was reviewed and approved by the Ethics Committee at Nihon University Itabashi Hospital (RK- 230509-5).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003e Patient characteristics and follow-up data were obtained retrospectively from our hospital records. Patient background at the time of PCI for ACS was anonymized and extracted, including information such as age, gender, body mass index (BMI), smoking history, comorbidities (hypertension, diabetes, dyslipidemia, or prior coronary disease), hemodynamic parameters (heart rate, systolic blood pressure, and diastolic blood pressure), laboratory tests (hemoglobin (Hb) concentration, lactate levels, creatine kinase (MaxCK) and estimated glomerular filtration rate [eGFR]), and transthoracic echocardiographic parameters (left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume [LVEDV], and left ventricular end-systolic volume [LVESV]) obtained at the time of the emergency coronary angiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at discharge were used for analysis. Cardiogenic shock is defined by the following three criteria: 1) SBP\u0026thinsp;\u0026lt;\u0026thinsp;90 mm Hg with appropriate fluid resuscitation and clinical and laboratory evidence of end-organ damage, 2) Clinical signs may include cold extremities, oliguria, altered mental status, and a narrow pulse pressure, or 3) Laboratory findings may reveal metabolic acidosis, elevated serum lactate, and elevated serum creatinine [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. MCS was implanted upon admission in cases of cardiogenic shock or if cardiogenic shock occurred during the procedure. Either Impella or IABP were implanted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImplantation of mechanical circulatory support and post-MI medical treatments\u003c/h2\u003e \u003cp\u003eThe Impella is generally used in cases of cardiogenic shock during PCI for anterior STEMI. The choice between the Impella and the IABP is made at the physicians' discretion. In all cases, both the Impella and the IABP were inserted just before PCI. The Impella used either 2.5 or CP. After PCI, patients were transferred to the coronary care unit for intensive care. The IABP and the Impella were removed once the patients' heart failure conditions stabilized, following the initiation of β-blocker and RAS inhibitor treatments. Subsequently, patients were transferred to a general ward for cardiac rehabilitation, with careful adjustment of cardioprotective agents. CMRI was performed before hospital discharge, after tapering off all vasopressor agents, including dobutamine infusions. The Impella and IABP groups were retrospectively compared, and follow-up CMRI was performed during the chronic phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCardiac Magnetic Resonance Imaging\u003c/h2\u003e \u003cp\u003eAll patients underwent CMRI before discharge and during the chronic phase. All images were acquired using a 1.5-T scanner (Ingenia; Philips Healthcare, Eindhoven, Netherlands) with retrospective electrocardiographic gating and a dS Torso coil. LV analysis was performed offline using commercially available software (cvi42, version 4.1.8, Circle Cardiovascular Imaging, Calgary, Canada). The CMRI protocol included standard steady-state free precession (SSFP) cine and late gadolinium enhancement (LGE) MRI. Standard SSFP cine images covered the entire LV using short-axis slices and 2-, 3-, and 4-chamber views with a temporal resolution of \u0026lt;\u0026thinsp;40 ms. Endo- and epicardial LV contours were manually drawn on short-axis cine images covering the mitral valve to the apex at end-diastole and end-systole to calculate end-diastolic and end-systolic volumes, stroke volume, and ejection fraction. LV mass was calculated as the sum of myocardial volumes, multiplied by the specific gravity (1.05 g/mL) of the myocardial tissue. Papillary muscles were excluded from the calculation of LV mass. For LV strain analysis, endo- and epicardial borders were semi-automatically drawn at end-diastole in short- and long-axis cines, excluding papillary muscles from the endocardial contour, and automatically propagated to all slices throughout the cardiac cycle. Short-axis cines were tracked to derive radial and circumferential strain, while 2-, 3-, and 4-chamber-view cines were tracked to derive longitudinal strain. Based on the 16-segment model, the software algorithm calculated 2D peak strains (longitudinal, radial, and circumferential) by averaging the corresponding peak values of the segments. In all analyses, strain was defined as the average of the peaks of the global, infarcted, and non-infarcted strain curves. Systolic strain rate (SR) was the average of the peaks of the global, infarcted, and non-infarcted SR curves during systole, and diastolic SR was the peak during diastole. LGE imaging was acquired using a T1-weighted inversion recovery gradient-echo sequence 15 minutes after contrast administration (0.15 mmol/kg; Gd-BTDO3A; Gadovist, Bayer Japan, Tokyo, Japan) in three long-axis slices (2-, 3-, and 4-chamber views) and a stack of short-axis slices completely encompassing the LV. The infarct size was quantified using the full-width at half-maximum method. This method estimated an intensity threshold from the remote myocardium, which is the midpoint between the mean intensity within the remote region and the maximum intensity within the affected tissue in the short-axis. The LV myocardium was divided into infarcted and non-infarcted areas. The division followed the segmental coronary artery distribution model outlined in the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines. The infarcted area was defined as the proximal LAD perfusion territory, which included segments 1\u0026ndash;2, 7\u0026ndash;8, and 13\u0026ndash;16. The remaining LV myocardium was designated as the non-infarcted area [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy assessments\u003c/h2\u003e \u003cp\u003eCMRI included measurements of LVEF, LVEDV, LVESV, and infarct size. Strain analysis involved longitudinal, radial, and circumferential peak systolic and diastolic SRs in the global, infarcted, and non-infarcted areas. Clinical events were also documented, including hospitalization due to heart failure, all-cause death, non-fatal MI, stroke, stent thrombosis, and major bleeding, as recorded in medical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), median and interquartile ranges, and number and percentages. Continuous variables between the groups were analyzed using the Mann-Whitney U-test. Differences in categorical variables were assessed using Fisher's exact test or the chi-squared test. All analyses were conducted using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA), with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics of the Impella and IABP Groups\u003c/h2\u003e \u003cp\u003eA total of 12 patients participated in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e) : five in the Impella group (four with Impella 2.5 and one with Impella CP) and seven in the IABP group. All patients had anterior wall STEMI. There were no significant differences in age (67\u0026thinsp;\u0026plusmn;\u0026thinsp;10 vs. 63\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years, p\u0026thinsp;=\u0026thinsp;0.53) and male sex (80% vs 86%, p\u0026thinsp;=\u0026thinsp;1.0) between the two groups. The BMI was significantly lower in the Impella group (21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 vs. 24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 kg/m\u0026sup2;, p\u0026thinsp;=\u0026thinsp;0.01). There were no differences in current smoking, hypertension, diabetes mellitus, or dyslipidemia, heart rate, systolic blood pressure, diastolic blood pressure, or other hemodynamic variables between the two groups at the time of hospital admission. There was no difference in lactate levels at presentation (2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 vs. 2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 mmol/l, p\u0026thinsp;=\u0026thinsp;0.66), renal function and Hb levels. Mechanical ventilation was used in one case in both groups.\u003c/p\u003e \u003cp\u003eEchocardiography on admission showed no significant differences in LVEF, LVEDV, and LVESV (51\u0026thinsp;\u0026plusmn;\u0026thinsp;11 vs. 50\u0026thinsp;\u0026plusmn;\u0026thinsp;9%, p\u0026thinsp;=\u0026thinsp;1.0, 107\u0026thinsp;\u0026plusmn;\u0026thinsp;18 vs. 104\u0026thinsp;\u0026plusmn;\u0026thinsp;28 ml, p\u0026thinsp;=\u0026thinsp;0.76, 47\u0026thinsp;\u0026plusmn;\u0026thinsp;17 vs. 46\u0026thinsp;\u0026plusmn;\u0026thinsp;15 ml, p\u0026thinsp;=\u0026thinsp;1.0). All patients had occlusion of the proximal part of the LAD, and all patients had TIMI 3 blood flow using a drug-eluting stent, which was completed without complications. There was no significant difference in maximum CK levels between the Impella and IABP groups (2595 [2069\u0026ndash;12932] vs 4372 [2941\u0026ndash;5601] IU/L, p\u0026thinsp;=\u0026thinsp;0.76). There was no significant difference in the duration that the MCS was in place. There were no significant differences in the use of antiplatelet agents, renin-angiotensin system (RAS) inhibitors, beta-blockers, or statins at the time of discharge. There was no statistically significant difference in the time to CMRI between the Impella and IABP groups, in both the acute and chronic phases (18 [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] vs. 14 [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] days, p\u0026thinsp;=\u0026thinsp;0.43; 118 [102\u0026ndash;242] vs. 117 [101\u0026ndash;202] days, p\u0026thinsp;=\u0026thinsp;1.0) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics between patients with IMPELLA and IABP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpella\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5, 2.5:4 CP:1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIABP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (m\u003csup\u003e2\u003c/sup\u003e/kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodynamic variables on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate (beats/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026thinsp;\u0026plusmn;\u0026thinsp;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory or comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior coronary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood values on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactate (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR (mL/min/1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood values at discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNT-proBNP at discharge (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e560 [71,2184]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1662[854,2498]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVA ECMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior STEMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfarct-related artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft main stem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft anterior descending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultivessel disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStent placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug-eluting stent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial TIMI flow 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal TIMI flow3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMax CK (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2595[2069\u0026ndash;12932]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4372[2941\u0026ndash;5601]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMax CK MB (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284[156\u0026ndash;936]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307[263\u0026ndash;386]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoor to balloon time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcho parameter on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDV (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104\u0026thinsp;\u0026plusmn;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVESV (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE (cm/sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA(cm/sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of MCS support (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedications at discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAPT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRAS inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeta blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange of medication at chronic CMRI phase (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of coronary care unit (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7[\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of hospital admission (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23[20\u0026ndash;28]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 [19\u0026ndash;34]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of CMRI after admission (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14[\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of follow up CMRI after admission (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118[102\u0026ndash;242]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 [101\u0026ndash;202]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are shown as the number (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (interquartile ranges).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSTEMI, ST-elevation myocardial infarction; BMI, body mass index; Hb, haemoglobin; eGFR, estimated glomerular filtration rate; DAPT, dual antiplatelet therapy; CPA, cardiopulmonary arrest; IABP, intra-aortic balloon pumping; VA ECMO, veno-arterial extracorporeal membrane oxygenation; LVEDV, left ventricular end-diastole volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; NT-pro BNP, n-terminal pro brain natriuretic peptide; TIMI, thrombolysis in myocardial infarction; CK, creatinine kinase; DES, drug eluting stent; CMRI, cardiac magnetic resonance image; N.A., not applicable\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAcute CMRI Assessment Between the Impella and IABP Groups\u003c/h2\u003e \u003cp\u003eRegarding the acute CMRI assessment, the LVEF was notably higher in the Impella group (49\u0026thinsp;\u0026plusmn;\u0026thinsp;10% vs. 36\u0026thinsp;\u0026plusmn;\u0026thinsp;8%, p\u0026thinsp;=\u0026thinsp;0.03), but the LVEDV, LVESV, and LGE showed no statistically significant differences between the two groups (141\u0026thinsp;\u0026plusmn;\u0026thinsp;30 ml vs. 176\u0026thinsp;\u0026plusmn;\u0026thinsp;46 ml, p\u0026thinsp;=\u0026thinsp;0.20; 72\u0026thinsp;\u0026plusmn;\u0026thinsp;23 ml vs. 112\u0026thinsp;\u0026plusmn;\u0026thinsp;46 ml, p\u0026thinsp;=\u0026thinsp;0.15; 26\u0026thinsp;\u0026plusmn;\u0026thinsp;11% vs. 28\u0026thinsp;\u0026plusmn;\u0026thinsp;13%, p\u0026thinsp;=\u0026thinsp;0.84) (Fig.\u0026nbsp;2.3). The Impella group had numerically better GRS (24\u0026thinsp;\u0026plusmn;\u0026thinsp;9% vs. 15\u0026thinsp;\u0026plusmn;\u0026thinsp;7%, p\u0026thinsp;=\u0026thinsp;0.11), GLS (-9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2% vs. -8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6%, p\u0026thinsp;=\u0026thinsp;0.88), and GCS (-14\u0026thinsp;\u0026plusmn;\u0026thinsp;4% vs. -10\u0026thinsp;\u0026plusmn;\u0026thinsp;4%, p\u0026thinsp;=\u0026thinsp;0.15), but all were not statistically significant compared to the IABP group. Systolic strain rate in radial, longitudinal, and circumferential parameters also showed a similar trend, but none were significant between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, the Impella group demonstrated a significant improvement in global radial diastolic strain rate (RDSR) and CDSR (-1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 vs. -0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 s⁻\u0026sup1;, p\u0026thinsp;=\u0026thinsp;0.01; 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 vs. 0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 s⁻\u0026sup1;, p\u0026thinsp;=\u0026thinsp;0.018) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Furthermore, the RDSR for in non-infarcted area (-2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 vs. -1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 s⁻\u0026sup1;, p\u0026thinsp;=\u0026thinsp;0.003) and CDSRs for both infarcted area (0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 vs. 0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 s⁻\u0026sup1;, p\u0026thinsp;=\u0026thinsp;0.048) and non-infarcted area (1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 vs. 0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 s⁻\u0026sup1;, p\u0026thinsp;=\u0026thinsp;0.003) were significantly better in the Impella group than in the IABP group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAcute and Chronic CMRI strain parameters between the patients with IMPELLA and IABP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMRI\u003c/p\u003e \u003cp\u003estrain parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpella(Acute)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIABP(Acute)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImpella\u003c/p\u003e \u003cp\u003e(Chronic)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIABP\u003c/p\u003e \u003cp\u003e(Chronic)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV Radial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Infarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e31\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLV Longitudinal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Infarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-13\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-12\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-11\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-8\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLV Circumferential\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-14\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-10\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-15\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-11\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-13\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-9\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-13\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-10\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Infarcted area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Strain (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-17\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-12\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-17\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-14\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e-1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e-0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic strain rate (1/s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCMRI, cardiac magnetic resonance image; LV, left ventricular\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eChronic CMRI Assessment Between the Impella and IABP Groups\u003c/h2\u003e \u003cp\u003eRegarding the chronic CMRI assessment, the Impella group exhibited a notably higher LVEF (54\u0026thinsp;\u0026plusmn;\u0026thinsp;9% vs. 39\u0026thinsp;\u0026plusmn;\u0026thinsp;5%, P\u0026thinsp;=\u0026thinsp;0.018) and smaller LVESV (65\u0026thinsp;\u0026plusmn;\u0026thinsp;16 mL vs. 110\u0026thinsp;\u0026plusmn;\u0026thinsp;38 mL, P\u0026thinsp;=\u0026thinsp;0.03). However, there was no significant difference in LVEDV between the two groups (Fig.\u0026nbsp;2.3). A significant improvement in GLS was observed in the Impella group (-9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3% vs. -6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2%, P\u0026thinsp;=\u0026thinsp;0.01), but GRS and GCS also showed numerically better results but did not exhibit significant differences between the two groups during the chronic phase (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This improvement was due to the lack of change in GLS from the acute to chronic phase in the Impella group, compared to a significant decrease in the IABP group (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). All diastolic strain rates, including radial, circumferential, and longitudinal, were not significantly different between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eClinical Outcomes\u003c/h2\u003e \u003cp\u003eNone of the 12 patients in the two groups experienced clinical events, including hospitalization due to heart failure, all-cause death, non-fatal MI, stroke, stent thrombosis, or major bleeding, by the time of their chronic CMRI.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study uncovered three significant findings. First, the LVEF was higher with Impella compared to IABP during the acute phase. Second, both global RDSR and CDSR as well as those in the non-infarcted area, were significantly better in the Impella group during the acute phase. Third, during the chronic phase, LVEF continued to be higher in the Impella group, and GLS was better preserved within the Impella group.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e1. Clinical outcomes, and Recovery of LVEF and Diastolic Strain Rate in the Acute Phase\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eSeveral studies comparing Impella and IABP have been published. Many of these studies indicate that in-hospital mortality and adverse clinical procedural outcomes are higher in the Impella group in acute myocardial infarction with cardiogenic shock (AMICS) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The frequency of hemorrhagic complications is notably higher in the Impella group, with reports indicating that the 30-day mortality rate is similar for both IABP and Impella [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, there are reports that Impella CP can be used before PCI in AMICS patients without cardiac arrest, with good results [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, a meta-analysis of patients with AMICS who received Impella before and after PCI showed better survival at 30 days and 6 months pre-PCI compared to post-PCI Impella placement, with no adverse events [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our study was a small, single-center comparison, and 30-day mortality was not observed in either group.\u003c/p\u003e \u003cp\u003eOur CMRI data showed no significant difference between the two groups in LGE, despite the previously reported effect of Impella on infarct size reduction [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, GRS, GLS, and GCS showed a numerically better results, but none were statistically significant. Nevertheless, we found greater LVEF and better values of global RDSR and CDSR, particularily in the non-infarcted area, during the acute phase in the Impella group. A recent report demonstrated that the CDSR serve as an effective index to predict the long-term risk of major cardiac adverse events and cardiac remodeling in patients with AMI [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, our findings may support beneficial effects, even on early cardiac remodeling, by Impella.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2. Maintaining GLS and improving LVEF in the Chronic Phase with Impella\u003c/h2\u003e \u003cp\u003eThe effectiveness of Impella in improving diastolic function, as indicated by RDSR and CDSR, in the acute phase, almost disappeared in the chronic phase. However, regarding LVEF in the chronic phase, the Impella group maintained a higher LVEF compared to the IABP group. Our follow-up is shorter (approximately 120 days after MI), but this aligns with a report showing that LVEF and LV diameter at 2 years improved with the use of Impella in patients with STEMI and other conditions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, this study also demonstrated that GLS remained stable in the Impella group from the acute to the chronic period, surpassing the IABP group in chronic GLS values. While the exact mechanism behind the abolition of diastolic functions in the acute phase among the Impella group remains unclear, it may be attributed to the typical reduction in both systolic and diastolic functions seen after myocardial infarction, particularly in the chronic phase [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. GLS is known to significantly impact myocardial damage, LVEF, and major adverse cardiac events [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Thus, the protective effect of Impella on diastolic function in both the global and non-infarcted areas during the acute phase may have patially contributed to maintaining GLS and further improving LVEF in the chronic phase, approximately 4 months after the STEMI onset. An RCT has demonstrated that Impella significantly reduced all-cause mortality at 6 months compared to the non-Impella group, including IABP [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Notably, no studies have yet demonstrated a positive impact of Impella on early and chronic cardiac remodeling proccess, making this a significant finding in our study. However, the number of patients in our study is quite limited, and we are currently awaiting the results of the STEMI-DTU Trial (NCT03947619) being conducted in the USA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eFirst, our study's limitations include its retrospective design. Additionally, our data is the result of a single-center registry providing a limited number of patients with broad anterior STEMI. Fortunately, similar patient backgrounds were observed between the Impella and IABP groups, expect for BMI, but latent patient selection bias and/or treatment intervention method cannot be controlled for. This study focused on detailed CMR analysis in the acute and chronic phases after STEMI, so the difference in clinical event effects between the Impella group and IABP group cannot be assessed within this limited patient cohort.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis comprehensive MRI-based study demonstrated that implantation of Impella before PCI resulted in better LVEF and CDSR in the acute phase compared to IABP, and further led to the maintenance of both LVEF and GLS through the chronic phase. Unlike with IABP, the maintenance of GLS from the acute to chronic phase, brought about by Impella, significantly contributed to the reverse remodeling process.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eacute myocardial infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMICS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eacute myocardial infarction with cardiogenic shock\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecircumferential diastolic strain rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecardiac magnetic resonance image\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDTBT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edoor-to-balloon time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eeGFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eestimated glomerular filtration rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eglobal longitudinal strain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIABP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintra-aortic balloon pumping\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft anterior descending\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elate gadolinium enhancement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVEDV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular end-diastole volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVEF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular ejection fraction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLVESV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eleft ventricular end-systolic volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMechanical circulatory support,MI,myocardial infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eradial diastolic strain rate\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRAS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRenin-angiotensin system\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRandomised controlled trial\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRDSR\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estrain rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSFP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estandard steady-state free precession\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNT-proBNP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eN-terminal pro-brain natriuretic peptide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epercutaneous coronary intervention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esystolic strain rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTEMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eST-elevation myocardial infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eEthics\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;approval\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;and consent to participate\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e:\u0026nbsp;All procedures were performed according to the ethical standards of the institutional research committee, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study and its protocols were approved by the Institutional Review Board of Nihon University Itabashi Hospital (RK-\u0026nbsp;\u003cspan lang=\"\"\u003e230509-5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eConsent for publication\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003e:\u003c/span\u003e\u003c/strong\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;Not applicable.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eAvailability of data and materials:\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cspan lang=\"EN-US\"\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eCompeting interests\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan lang=\"EN-US\"\u003e:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003eDr. Okumura belongs to the endowed departments of Boston Scientific Japan, Abbott Medical Japan, Japan Lifeline, Medtronic Japan, and Nihon Kohden.\u003cspan lang=\"EN-US\"\u003eThe others have no competing interests.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eFunding\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cspan lang=\"EN-US\"\u003e: Not applicable.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eAuthors\u0026rsquo; contributions:\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e AY had analyzed CMR data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003eAcknowledgments\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan lang=\"EN-US\"\u003e:\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI am sincerely grateful to Professor Atsushi Hirayama for giving me many wonderful lessons during the introduction period of Impella and for teaching me the importance of treatment of myocardial infarction at coronary care unit.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFabris E, Boldrin C, Gregorio C, et al. The Prognostic impact of treatments evolution in STEMI. Int J Cardiol:131352, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke Statistics-2017 update: A report from the American Heart Association. Circulation. 2017;135:e146-603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Ohman EM, Desch S, et al. Management of cardiogenic shock. Eur Heart J 2015;36:1223\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Bijl P, Abou R, Goedemans L, et al. Left Ventricular Post-Infarct Remodeling: Implications for Systolic Function Improvement and Outcomes in the Modern Era. JACC Heart Fail 8(2):131\u0026ndash;140, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTawfik W, El-Sherif A, Bendary A, Mahros M, Salem M. Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Echocardiography 37(4):570\u0026ndash;577, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolzknecht M, Reindl M, Tiller C, et al. Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters. Clin Res Cardiol 110(10):1599\u0026ndash;1611, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFukamachi D, Yamada A, Ohgaku A, et al. Protective effect of the Impella on the left ventricular function after acute broad anterior wall ST elevation myocardial infarctions with cardiogenic shock: cardiovascular magnetic resonance imaging strain analysis. BMC Cardiovasc Disord 22(1):201, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei L, Dong JX, Jin LX, et al. Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction. Radiol Med, 2023\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChatzis G, Syntila S, Schuett H, et al. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 10(6), 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J 2019;40:2671\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchrage B, Ibrahim K, Loehn T, et al. Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock. Circulation 139(10):1249\u0026ndash;1258, 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmarzooq ZI, Song Y, Dahabreh IJ, et al. Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock. JAMA Cardiol 8(8):744\u0026ndash;754, 2023\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlushi B, Douedari A, Froehlig G, et al. Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock. Open Heart 6(1):e000987, 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIannaccone M, Albani S, Giannini F, et al. Short term outcomes of Impella in cardiogenic shock: A review and meta-analysis of observational studies. Int J Cardiol 324:44\u0026ndash;51, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyashita S, Banlengchit R, Marbach JA, et al. Left Ventricular Unloading Before Percutaneous Coronary Intervention is Associated With Improved Survival in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 39:28\u0026ndash;35, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei L, Dong JX, Jin LX, et al. Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction. Radiol Med 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzevedo CF, Amado LC, Kraitchman DL, et al. Persistent diastolic dysfunction despite complete systolic functional recovery after reperfused acute myocardial infarction demonstrated by tagged magnetic resonance imaging. Eur Heart J 2004;25:1419\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChatzis G, Syntila S, Schuett H, et al. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 10(6), 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTawfik W, El-Sherif A, Bendary A, Mahros M, Salem M. Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Echocardiography 37(4):570\u0026ndash;577, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoller JE, Engstrom T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anterior ST-elevation myocardial infarction, Impella, cardiovascular magnetic resonance imaging","lastPublishedDoi":"10.21203/rs.3.rs-4534491/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4534491/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLate adverse myocardial remodeling after ST elevation myocardial infarction (STEMI) is strongly associated with cardiac death. Global Longitudinal strain (GLS) and circumferential diastolic strain rate (CDSR) derived cardiovascular magnetic resonance imaging (CMRI) is a powerful predictor of late myocardial remodeling. However, Impella\u0026rsquo;s effects on CMRI-based myocardial remodeling after STEMI is not fully understood.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively compared the CMRI-derived strain and left ventricular ejection fraction (LVEF) in the acute (18 [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]) vs 14 [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] days, P\u0026thinsp;=\u0026thinsp;0.43) and chronic phases (118 [102\u0026ndash;242] vs 117 [101\u0026ndash;202] days, P\u0026thinsp;=\u0026thinsp;1.0) after broad anterior STEMI.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive patients received an Impella before percutaneous coronary intervention (PCI), and 7 were given intra-aortic balloon pumping (IABP). There were no significant differences in age (67\u0026thinsp;\u0026plusmn;\u0026thinsp;10 vs. 63\u0026thinsp;\u0026plusmn;\u0026thinsp;13, P\u0026thinsp;=\u0026thinsp;0.53), peak creatine kinase levels (2595 [2069\u0026ndash;12932] vs. 4372 [2941\u0026ndash;5601] IU/L, P\u0026thinsp;=\u0026thinsp;0.76), and LVEF at admission (51\u0026thinsp;\u0026plusmn;\u0026thinsp;11 vs. 50\u0026thinsp;\u0026plusmn;\u0026thinsp;9%, P\u0026thinsp;=\u0026thinsp;1.0) between the two groups. The Impella group showed significantly better acute CMRI-derived LVEF (49\u0026thinsp;\u0026plusmn;\u0026thinsp;10 vs. 36\u0026thinsp;\u0026plusmn;\u0026thinsp;8%, P\u0026thinsp;=\u0026thinsp;0.03) and CDSR (0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 vs. 0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 s⁻\u0026sup1;, P\u0026thinsp;=\u0026thinsp;0.018) despite no significant difference in acute GLS between the two groups (-9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 vs. -8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6%, P\u0026thinsp;=\u0026thinsp;0.88). In the chronic phase, CMRI-derived LVEF and GLS were significantly higher in the Impella group (54\u0026thinsp;\u0026plusmn;\u0026thinsp;9 vs. 39\u0026thinsp;\u0026plusmn;\u0026thinsp;5%, P\u0026thinsp;=\u0026thinsp;0.018; -9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 vs. -6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2%, P\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Impella implantation leads to better LVEF and CDSR in the acute phase compared to IABP, and further to maintenance of both LVEF and GLS through the chronic phase. Unlike with IABP, LV unloading brought about by Impella, significantly contributed to the reverse remodeling process.\u003c/p\u003e","manuscriptTitle":"Impella Effects on Reverse Myocardial Remodeling in Anterior ST-Elevation Myocardial Infarction: Insights from a Comprehensive Analysis of Acute and Chronic MRI Findings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-26 19:03:31","doi":"10.21203/rs.3.rs-4534491/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5a72ca7-16cd-4fe5-b2dd-60ada558abef","owner":[],"postedDate":"June 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33446612,"name":"Health sciences/Cardiology"},{"id":33446613,"name":"Health sciences/Diseases"}],"tags":[],"updatedAt":"2024-10-28T08:09:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-26 19:03:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4534491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4534491","identity":"rs-4534491","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}