Prognostic Value of Follow-up Measures of Left Ventricular Global Longitudinal Strain in Patients With ST-Segment Elevation Myocardial Infarction - 03/07/24
Abstract |
Introduction |
After ST-segment elevation myocardial infarction (STEMI), follow-up imaging is currently recommended only in patients with left ventricular ejection fraction (LVEF) <40%. Left ventricular global longitudinal strain (LVGLS) was shown to improve risk stratification over LVEF in these patients but has not been thoroughly studied during follow-up. The aim of this study was to explore the changes in LVGLS after STEMI and their potential prognostic value.
Materials and Methods |
Data were analyzed from an ongoing STEMI registry. Echocardiography was performed during the index hospitalization and 1 year after STEMI; LVGLS was expressed as an absolute value and the relative LVGLS change (ΔGLS) was calculated. The study end point was all-cause mortality.
Results |
A total of 1,409 STEMI patients (age 60 ± 11 years; 75% men) who survived at least 1 year after STEMI and underwent echocardiography at follow-up were included. At 1-year follow-up, LVEF improved from 50% ± 8% to 53% ± 8% (P < .001) and LVGLS from 14% ± 4% to 16% ± 3% (P < .001). Median ΔGLS was 14% (interquartile range, 0.5%-32%) relative improvement. Starting 1 year after STEMI, a total of 87 patients died after a median follow-up of 69 (interquartile range, 38-103) months. The optimal ΔGLS threshold associated with the end point (derived by spline curve analysis) was a relative decrease >7%. Cumulative 10-year survival was 91% in patients with ΔGLS improvement or a nonsignificant decrease, versus 85% in patients with ΔGLS decrease of >7% (P = .001). On multivariate Cox regression analysis, ΔGLS decrease >7% remained independently associated with the end point (hazard ratio, 2.5 [95% CI, 1.5–4.1]; P < .001) after adjustment for clinical and echocardiographic parameters.
Conclusions |
A significant decrease in LVGLS 1 year after STEMI was independently associated with long-term all-cause mortality and might help further risk stratification and management of these patients during follow-up.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Prognostic value of change in LVGLS after STEMI.
Prognostic value of change in LVGLSleft ventricular global longitudinal strain after STEMI-elevation myocardial infarction.
Central IllustrationPrognostic value of change in LVGLSleft ventricular global longitudinal strain after STEMI-elevation myocardial infarction.Le texte complet de cet article est disponible en PDF.
Highlights |
• | At baseline after STEMI, LVEF and LVGLS are on average preserved or mildly reduced. |
• | At 1 year after STEMI LV systolic function has improved in most patients. |
• | A >7% relative decrease in LVGLS is linked to 2.5 times higher all-cause mortality. |
Keywords : ST-Segment elevation myocardial infarction, Left ventricular global longitudinal strain
Abbreviations : ΔGLS, HF, HR, IQR, LV, LVEF, LVGLS, MI, STEMI, TTE
Plan
| Neil J. Weissman, MD, served as guest editor for this report. |
Vol 37 - N° 7
P. 666-673 - juillet 2024 Retour au numéro
Article précédent
- Are We Ready to Let AI Replace the Human “Eye” When Looking for Wall Motion Abnormalities?
- Casey L. Johnson, Paul Leeson
- Global Longitudinal Strain: An Additional Tool to Improve Risk Stratification in Patients After ST-Segment Elevation Myocardial Infarction?
- Rory B. Weiner
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