Abstract
Background
Depression of left ventricular function is common phenomenon after acute myocardial infarction and it's often associated with poor prognosis. However, substantial portion of patients with acute myocardial infarction had normal left ventricular function by assessment of left ventricular ejection fraction.
Purpose
In this study, we examined role of left ventricular global longitudinal strain assessment in patients who had normal ejection fraction after acute myocardial infarction.
Methods
We choose patients with acute myocardial infarction who were successfully treated with primary percutaneous coronary intervention (PCI). All of those patients had normal ejection fraction (EF≥55%) in routine echocardiographic examination within 3 days after acute myocardial infarction. Two dimensional speckle tracking echocardiography was used to assess left ventricular global longitudinal strain. Based on existence of newly onset clinical signs (pulmonary edema, lung crackles, peripherial edema etc.) of heart failure patients divided into case and control group. Patients who had other etiology or previous heart failure were excluded.
Results
A total of 153 patients with AMI were selected and newly onset heart failure is occurred in 20 patients. Left ventricular global strain was significantly different between patients with clinical heart failure and patients without clinical heart failure (−11.1±1.85% vs. −16.6±3.38%, p<0.001). After adjustment of possible predictors of impaired left ventricular function such as, age, gender, hypertension, diabetes, previous coronary artery disease, cardiac troponin, mitral inflow EA ratio, deceleration time, left ventricular end diastolic volume, ejection fraction, mitral annulus EE' ratio and wall motion score index, global longitudinal strain was independent predictor of clinical heart failure (odds ratio 1.79, 95% CI 1.22–2.65, p=0.003). Adding global longitudinal strain into above mentioned predictors of clinical heart failure after acute myocardial infarction is associated with significantly increased c-statistic (0.93, 95% CI 0.87–0.99 vs. 0.97, 95% CI 0.94–0.99, p<0.001).
Conclusion
Left ventricular global longitudinal strain is independently associated with clinical heart failure in patients with preserved ejection fraction after acute myocardial infarction. Adding global longitudinal strain parameter into screening model may increase rate of precise determination of clinical heart failure after acute myocardial infarction.
Funding Acknowledgement
Type of funding source: None
Echocardiographic longitudinal strain identifies myocardial viability and predicts left ventricular function and remodeling after acute myocardial infarction with systolic dysfunction
