A 68-year-old man with a non-ST elevation myocardial infarction (NSTEMI) presented with a low risk profile indicating invasive revascularization within 72 h. However, left ventricular (LV) global longitudinal strain (GLS) calculated by two-dimensional speckle tracking echocardiography (2D-STE) in the Emergency Room showed substantial myocardial infarction. Therefore, urgent reperfusion therapy was decided and delivered within 30 min from hospital admission. LV GLS fully recovered after the invasive procedure and the final infarct size was 7%. This case shows that very early revascularization in NSTEMI patients can be guided by 2D-STE and might be considered for those patients with substantial LV myocardial infarction.

1.
Lomoriello VS, Galderisi M, Rapacciuolo A, et al: Serial speckle tracking and successful post-STEMI percutaneous coronary intervention: incremental value versus visual wall motion analysis. J Cardiovasc Med (Hagerstown) 2010; 11: 768–771.
2.
Eek C, Grenne B, Brunvand H, et al: Strain echocardiography and wall motion score index predicts final infarct size in patients with Non-ST-segment-elevation myocardial infarction. Circ Cardiovasc Imaging 2010; 3: 187–194.
3.
Barbier P, Mirea O, Cefalù C, et al: Reliability and feasibility of longitudinal AFI global and segmental strain compared with 2D left ventricular volumes and ejection fraction: intra- and inter-operator, test-retest, and inter-cycle reproducibility. Eur Heart J Cardiovasc Imaging 2015; 16: 642–652.
4.
Roffi M, Patrono C, Collet JP, et al: 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC). Eur Heart J 2016; 37: 267–315.
5.
Dixon WC, Wang TY, Dai D, et al: Anatomic distribution of the culprit lesion in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: findings from the National Cardiovascular Data Registry. J Am Coll Cardiol 2008; 52: 1347–1348.
6.
Kontos MC, Kurdziel KA, Ornato JP, et al: A nonischemic electrocardiogram does not always predict a small myocardial infarction: results with acute myocardial perfusion imaging. Am Heart J 2001; 141: 360–366.
7.
Martin TN, Groenning BA, Murray HM, et al: ST-segment deviation analysis of the admission 12-lead electrocardiogram as an aid to early diagnosis of acute myocardial infarction with a cardiac magnetic resonance imaging gold standard. J Am Coll Cardiol 2007; 50: 1021–1028.
8.
Lieberman AN, Weiss JL, Jugdutt BI, et al: Two-dimensional echocardiography and infarct size: relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog. Circulation 1981; 63: 739–746.
9.
Mele D, Pasanisi G, Heimdal A, et al: Improved recognition of dysfunctioning myocardial segments by longitudinal strain rate versus velocity in patients with myocardial infarction. J Am Soc Echocardiogr 2004; 17: 313–321.
10.
Liel-Cohen N, Tsadok Y, Beeri R, et al: A New tool for automatic assessment of segmental wall motion based on longitudinal 2D strain: a multicenter study by the Israeli Echocardiography Research Group. Circ Cardiovasc Imaging 2010; 3: 47–55.
11.
D’Andrea A, Radmilovic J, Mele D, et al: Speckle tracking analysis in intensive care unit: a toy or a tool? Echocardiography 2018; 35: 506–519.
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