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Background: High neutrophil to lymphocyte ratio (NLR) is independently associated with lower EF, in hospital complications, and higher mortality rates in acute myocardial infarction (AMI). Global longitudinal strain (GLS) measurement after AMI demonstrated specific benefit compared with LVEF in evaluation of the extent of post MI left ventricular myocardial injury. The aim of this study was to determine the association between NLR and left ventricular GLS in AMI patients.Methods: An analytic observational study was conducted on August-December 2017 to patients who admited to Dr. Moewardi General Hospital which diagnosed STEMI or NSTEMI. Blood examination and transthoracic echocardiography were performed. They were divided into two groups according to GLS measurement result, GLS>-13.8% and GLS≤-13.8%. The cut-off value of NLR to predict GLS>-13.8%was determined by ROC curve analysis. Bivariate and multivariate analysis to assess whether high NLR was associated with GLS>-13.8% were performed.Results: As many as 57 patients were included in this study, 24 patients (mean age 56,21±9,43) in GLS ≤-13.8% group and 33 patients (mean age 56.67±8.24) in GLS >-13.8%. NLR was significantly higher in GLS>-13.8% group 6.06 (5.36-6.86) compare 4.20 (3.49-5.04),in GLS≤-13.8%, p=0.001. The cut-off value of NLR was 4.69. The bivariate analysis showed that NLR>4.69 associated with GLS>-13.8%, OR 2.70 (CI 95% 1.41-5.17, p=0.001). Multivariate analysis shown that higher NLR have more probability to develop GLS>-13.8%, OR 8.53 (CI 95% 2.38-30.60, p<0.001).Conclusion: There is an association between NLR and left ventricular GLS in AMI patients. AMI patients with high NLR are more likely to have worse GLS.

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Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI). This study evaluate the diagnostic and prognostic significance of RV systolic and diastolic function compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients. Consecutive patients with first, acute, inferior STEMI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed within24 h of the onset of symptoms. Out of 31 patients (mean age 56.39 ± 9.02 years), RVMI was found in 18 (37%). Multivariate analysis showed that two variables—RV systolic and diastolic function, were independent predictors of in-hospital prognosis. Sensitivity and specificity the RV systolic function were 94,4% and 69,2%, respectively. While RV diastolic function were 44% and 76,9%, respectively. RV systolic function predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. RV diastolic function predict ECG diagnosis of RVMI with relatively low sensitivity but with high specificity.Keywords: tissue Doppler imaging, RV myocardial infarction, inferior myocardial infarction

Wellens' Syndrome (WS) is a clinical presentation of ischemic chest pain with deep and symmetrical T wave or biphasic T wave inversion in V1 or V2 until V4 or V5 in electrocardiography finding and critical lesion in proximal Left Anterior Descenden (LAD) coronary artery. This case report discuss male 51 year old with typical chest pain and the ECG showed deep T-wave inversion in V1-V5. Transient ST elevation in V1-V5 appeared in 4th day of hospitalization without increasing cardiac markers. Coronary angiography examination demonstrated critical stenosis in proximal LAD (90%). Here we discuss about Wellens' syndrome clinical manifestation, ECG and coronary angiography presentation, and also anterior wall Myocardial infarction as a consequences of WS. Early detection and prompt management can prevent anterior wall MI and mortality.