scholarly journals GLOBAL LONGITUDINAL STRAIN IMPROVES RISK ASSESSMENT AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: A COMPARATIVE PROGNOSTIC EVALUATION OF LEFT VENTRICULAR FUNCTIONAL PARAMETERS

2021 ◽  
Vol 77 (18) ◽  
pp. 1311
Author(s):  
Magdalena Holzknecht ◽  
Martin Reindl ◽  
Christina Tiller ◽  
Sebastian Johannes Reinstadler ◽  
Ivan Lechner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Assessment ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Prognostic Evaluation ◽  
St Segment Elevation ◽  
Functional Parameters ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters

2021 ◽  
Author(s):  
Magdalena Holzknecht ◽  
Martin Reindl ◽  
Christina Tiller ◽  
Sebastian J. Reinstadler ◽  
Ivan Lechner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
St Segment Elevation ◽  
Functional Parameters ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aim We aimed to investigate the comparative prognostic value of left ventricular ejection fraction (LVEF), mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by cardiac magnetic resonance (CMR) in patients after ST-segment elevation myocardial infarction (STEMI). Methods and results This observational cohort study included 445 acute STEMI patients treated with primary percutaneous coronary intervention (pPCI). Comprehensive CMR examinations were performed 3 [interquartile range (IQR): 2–4] days after pPCI for the determination of left ventricular (LV) functional parameters and infarct characteristics. Primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as composite of death, re-infarction and congestive heart failure. During a follow-up of 16 [IQR: 12–49] months, 48 (11%) patients experienced a MACE. LVEF (p = 0.023), MAPSE (p < 0.001), LAS (p < 0.001) and GLS (p < 0.001) were significantly related to MACE. According to receiver operating characteristic analyses, only the area under the curve (AUC) of GLS was significantly higher compared to LVEF (0.69, 95% confidence interval (CI) 0.64–0.73; p < 0.001 vs. 0.60, 95% CI 0.55–0.65; p = 0.031. AUC difference: 0.09, p = 0.020). After multivariable analysis, GLS emerged as independent predictor of MACE even after adjustment for LV function, infarct size and microvascular obstruction (hazard ratio (HR): 1.13, 95% CI 1.01–1.27; p = 0.030), as well as angiographical (HR: 1.13, 95% CI 1.01–1.28; p = 0.037) and clinical parameters (HR: 1.16, 95% CI 1.05–1.29; p = 0.003). Conclusion GLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as angiographical and clinical characteristics with superior prognostic validity compared to LVEF. Graphic abstract

scholarly journals Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment–Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Rodolfo P. Lustosa ◽  
Steele C. Butcher ◽  
Pieter van der Bijl ◽  
Mohammed El Mahdiui ◽  
Jose M. Montero-Cabezas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Lv Ejection Fraction

Background: Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction in patients with ST-segment–elevation myocardial infarction. However, LV global longitudinal strain does not take into consideration the effect of afterload. Novel speckle-tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV global longitudinal strain. The present study aimed to investigate the prognostic value of global LV myocardial work efficiency (GLVMWE; reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with ST-segment–elevation myocardial infarction. Methods: A total of 507 ST-segment–elevation myocardial infarction patients (mean age, 61±11 years; 76% men) were retrospectively analyzed. LV ejection fraction and GLVMWE were measured by transthoracic echocardiography within 48 hours of admission. GLVMWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments and expressed as a percentage. Spline curve analysis was used to define the association between reduced GLVMWE and all-cause death. Results: After a median follow-up of 80 months (interquartile range, 67–97 months), 40 (8%) patients died. Patients with reduced GLVMWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% versus 4.7%; log-rank P <0.001) in comparison with patients with preserved GLVMWE (≥86%). Reduced GLVMWE (<86%) showed an independent association with all-cause mortality (hazard ratio, 3.167 [95% CI, 1.679–5.972]; P <0.001). Conclusions: Reduced GLVMWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in ST-segment–elevation myocardial infarction patients is associated with worse long-term survival.

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