scholarly journals Effects of sacubitril/valsartan in patients with a systemic right ventricle: early evidence of exercise tolerance and systolic function improvement

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Fusco ◽  
A Merola ◽  
G Scognamiglio ◽  
M Palma ◽  
A Correra ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Exercise Tolerance ◽  
Treatment Initiation ◽  
Systolic Function ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Walking Distance ◽  
Systemic Right Ventricle ◽  
Early Evidence

Abstract Background Sacubitril/valsartan has been shown to reduce mortality and morbidity inpatients with heart failure and reduced systolic function. However, the effects of this novel association in patients with congenital heart disease and a systemic right ventricle (sRV) have not been investigated yet. Purpose We aimed to assess tolerability and efficacy of sacubitril/valsartan in patients with a sRV Methods From September 2020 to March 2021, 38 patients with congenitally corrected transposition of the great arteries or transposition of the great arteries after Senning or Mustard repair were prospectively enrolled. Inclusion criteria were: age ≥18 years, optimal medical therapy including ACEi/ARB for at least 6 months and EF of the sRV ≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) <90mmHg, glomerular filtration rate (GFR) <30ml/min or K >5.5mEq/L were excluded. RV systolic function was assessed on echocardiography using a multiparametric evaluation. The study protocol contemplates serial assessments at 1, 3, 6 and 12 months after treatment initiation. Results Up to March 31th, 23 patients completed 1-month and 15 completed 3-month assessment after treatment initiation. Baseline patients' characteristics are summarized in table 1. The medication dose was up-titrated to the highest tolerated dose during follow-up. During early follow-up, no major adverse events were reported. Treatment did not impact significantly on the values of serum potassium (basal K+ 4.4 [4.2–4.6] mEq/L, K+ at 3 months 4.4 [4.3–4.6] mEq/L, p=0.7) and GFR (basal GFR 113.9±35ml/min, GFR at 3 months 107.8±21 ml/min, p=0.7). Although SBP did not change significantly (114±12 vs 113.9±19 mmHg at 1-month and 117.3±12 mmHg at 3 months; p=0.9 for both), 2 (5%) patients ceased the treatment due to symptomatic hypotension during the first month of treatment. There was no significant change in the NYHA class. However, the 6-minute walking distance increased significantly after 3 months (365±120 vs 498.3±71 min; p=0.01). Furthermore, while traditional echocardiographic parameters of RV systolic function (TAPSE, s wave and FAC) did not change significantly, RV global longitudinal strain (GLS) and RV free wall GLS demonstrated subclinical improvement in right ventricular systolic function (table 2). Conclusions Our short-term results from an ongoing prospective study showed that sacubitril/valsartan is well tolerated in patients with a sRV with early evidence of improvement in exercise tolerance and sRV systolic function. Longer follow-up is warranted to confirm these data. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Table 2

Global Longitudinal Strain May Identify Preserved Systolic Function of the Systemic Right Ventricle

2015 ◽  
Vol 31 (6) ◽  
pp. 760-766 ◽  
Author(s):  
Magdalena Lipczyńska ◽  
Piotr Szymański ◽  
Magdalena Kumor ◽  
Anna Klisiewicz ◽  
Łukasz Mazurkiewicz ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Systemic Right Ventricle

scholarly journals Sacubitril/valsartan in the treatment of systemic right ventricular failure

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318074
Author(s):  
Tjitske E Zandstra ◽  
Marieke Nederend ◽  
Monique R M Jongbloed ◽  
Philippine Kiès ◽  
Hubert W Vliegen ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Walking Distance ◽  
Angiotensin Ii Receptor ◽  
Systemic Right Ventricle ◽  
Atrial Switch ◽  
Receptor Blockers ◽  
Β Blocker ◽  
Laboratory Investigations

ObjectivePharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients.MethodsData on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment.ResultsSix-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively).ConclusionsWe describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.

scholarly journals Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

2014 ◽  
Vol 8 ◽  
pp. CMC.S14016 ◽  
Author(s):  
Carlo Lombardi ◽  
Valentina Carubelli ◽  
Valentina Lazzarini ◽  
Enrico Vizzardi ◽  
Filippo Quinzani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
New York ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Stress Test ◽  
Nyha Class ◽  
Heart Association

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

Mechanical circulatory support as a bridge to candidacy in adults with transposition of the great arteries and a systemic right ventricle

2020 ◽  
Author(s):  
Takayuki Gyoten ◽  
Sebastian V Rojas ◽  
Henrik Fox ◽  
René Schramm ◽  
Kavous Hakim-Meibodi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Waiting Time ◽  
Heart Transplant ◽  
Continuous Flow ◽  
Adult Patients ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Systemic Right Ventricle

Abstract OBJECTIVES Clinical experience with continuous flow ventricular assist devices (VADs) in patients with transposition of the great arteries (TGA) including dextro-TGA and congenitally corrected TGA is rare, and indications as well as potential benefits or specific hurdles remain unclear. Therefore, our goal was to report on our experience regarding VAD therapy in adult patients with TGA as a bridge to candidacy. METHODS We performed a single-centre retrospective study of all adult patients with TGA with systemic right ventricular failure who had continuous flow VAD implants between 2010 and 2018. Study end points were all causes of death, major cardiac and cerebrovascular adverse events or pump thrombosis. Follow-up continued until the time of the heart transplant. RESULTS A total of 6 patients (4 men) had a continuous flow VAD implanted in the context of a failing systemic right ventricle (dextro-TGA after the Mustard procedure: n = 3; congenitally corrected TGA: n = 3). Demographics: mean age 32 ± 5.7 years; median Interagency Registry for Mechanically Assisted Circulatory Support: level II (range 1–4), mean pulmonary artery 48 ± 13 mmHg, mean pulmonary vascular resistance 5.6 ± 3.5 Wood units. Postoperative data: intensive care unit stay: 16 ± 9.7 days; in-hospital survival: 100%; no early VAD-related complications occurred. Mean follow-up: 33 ± 18 months; persistent left-side paresis: n = 1; minor (non-disabling) stroke: n = 2. Post-VAD pulmonary artery: 19 ± 3.4 mmHg; P &lt; 0.005; post-VAD pulmonary resistance: 2.2 ± 0.55 Wood units; P = 0.066. Four patients had heart transplants after a mean waiting time of 30 months after the VAD was implanted; 2 patients are still on the waiting list (waiting time: 52 and 24 months). CONCLUSIONS Continuous flow VAD therapy is a feasible therapeutic option in adult patients with TGA and a failing systemic right ventricle as a bridge to candidacy and a bridge to a heart transplant.

A pilot study on the effects of carvedilol on right ventricular remodelling and exercise tolerance in patients with systemic right ventricle

2007 ◽  
Vol 114 (2) ◽  
pp. 241-246 ◽  
Author(s):  
Alessandro Giardini ◽  
Luigi Lovato ◽  
Andrea Donti ◽  
Roberto Formigari ◽  
Gaetano Gargiulo ◽  
...  
Keyword(s):  
Pilot Study ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Exercise Tolerance ◽  
Ventricular Remodelling ◽  
Systemic Right Ventricle

scholarly journals LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Khanna ◽  
I Wen ◽  
A Gupta ◽  
A Thakur ◽  
A Bhat ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Autoimmune Encephalitis ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Age And Gender ◽  
Immunological Disorders ◽  
Significant Difference ◽  
And Gender

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF &lt;50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p&lt;0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Adverse remodeling of the subpulmonary left ventricle in patient with systemic right ventricle is associated with clinical outcome

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
B Santens ◽  
F Helsen ◽  
A Van De Bruaene ◽  
P De Meester ◽  
A Budts ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Clinical Outcome ◽  
Right Ventricle ◽  
Prognostic Markers ◽  
Volume Index ◽  
Short Term ◽  
Systemic Right Ventricle ◽  
Adverse Remodeling

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research received project funding by KU Leuven Background – Early recognition of adverse remodeling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population.  Purpose - We aimed assessing short-term clinical evolution and early prognostic markers of cardiac complications in adults with sRV (atrial switch repair for D-transposition of the great arteries (D-TGA) and congenitally corrected transposition of the great arteries (ccTGA)) based on detailed phenotyping.  Methods– Thirty-three patients with sRV underwent detailed phenotyping including exercise CMR. Adverse outcome was a composite of heart failure episode and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed.  Results - Thirty-three patients (76% male) with sRV were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26-57) years at latest follow-up. When compared to baseline, (I) most patients remained in NYHA functional class I (76%),  (II) the degree of severity of the SAVV regurgitation rose and (III) more electrical instability was documented at latest follow-up. Six (18%) of a total of nine events were counted as first cardiovascular events (9% heart failure, 9% arrhythmia). NTproBNP (HR 11.02 (95%CI 1.296-93.662), p= 0.028), oxygen pulse (HR 1.202 (95% CI 1.012-1.428), p = 0.037), left ventricle end diastolic volume index (LVEDVi) in rest (HR 1.046 (95% CI 1.002-1.092), p = 0.041) and during exercise (HR 1.035 (95% CI 1.002-1.069), p = 0.038), stroke volume index (SVi) of the subpulmonary left ventricle (LV) in rest (HR 1.154 (95% CI 1.005-1.322), p = 0.038) and at peak exercise (HR 1.065 (95% CI 1.007-1.125), p = 0.026) were significantly associated with the first cardiovascular event (Figure 1A and B).  Conclusion – NTproBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodeling of the subpulmonary ventricle might be an early sign of a failing sRV circulation (Figure 2).

Validation of serial echocardiographic versus mri functional assessments in patients with a systemic right ventricle

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.E Zandstra ◽  
M.R.M Jongbloed ◽  
R.L Widya ◽  
A.D.J Ten Harkel ◽  
E.R Holman ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Correlation Coefficient ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Systemic Right Ventricle ◽  
Atrial Switch ◽  
Inter Observer Variability ◽  
Echocardiographic Images ◽  
Rv Function

Abstract Background Inherent to its geometry, echocardiographic imaging of the systemic right ventricle (sRV) may not always be feasible and/or reproducible in daily clinical practice. Here, we aim to validate the usefulness of all published echocardiographic measurements of systemic RV function in a longitudinal cohort by serial assessment of their correlations with cardiac magnetic resonance (CMR)-derived sRV ejection fraction (sRVEF). Methods A single-center, retrospective cohort study was performed. Adult patients with a sRV who underwent both CMR and echocardiography, at two different points in time, were included. Offline analysis of echocardiographic images was blinded to offline CMR analysis and vice versa. Measurements were repeated by a second observer blinded to the results of the first observer. Correlations between echocardiographic and CMR measures were assessed with Pearson's correlation coefficient and inter-observer variability was quantified with intraclass-correlation coefficients. Results Fourteen patients were included, of which 4 with congenitally corrected transposition of the great arteries (TGA) and 10 patients with TGA late after atrial switch. Eight patients (57%) were female. There was a mean of 8 years between the first and second imaging assessment. The average CMR-derived sRVEF was 39±6% at t=1. Only global systemic RV function (r=−0.77, p=0.002 at t=1, r=−0.63, p=0.024 at t=2), fractional area change (FAC; r=0.79, p=0.001 at t=1, r=0.67 and p=0.018 at t=2) and global longitudinal strain (GLS; r=−0.73 and p=0.005 at t=1 and r=−0.70 and p=0.011 at t=2) correlated consistently with CMR-sRVEF at both time points. The intraclass-correlation coefficient of GLS was consistently more favorable than that of FAC. Conclusion Out of the published echocardiographic parameters, GLS is the most robust measurement of sRV function in terms of feasibility, interobserver variability and correlation with CMR sRVEF. Figure 1. Echocardiographic assessment Funding Acknowledgement Type of funding source: None

P2267CTEPH patients long term follow-up: results from a single center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mladoniczky ◽  
M Szegedi ◽  
Z S Piroth ◽  
J Nemeth ◽  
L Ablonczy ◽  
...  
Keyword(s):  
Nyha Class ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Walking Distance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Post Surgery ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available. Objective We investigated the long term outcome of our CTEPH patients. Methods CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up. Results Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively. Conclusions 55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.

4938Left ventricular global longitudinal strain recovery predicts scar size reduction and systolic remodelling post ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Vo ◽  
T Nguyen ◽  
A Chen ◽  
J French ◽  
J Otton ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Scar Size ◽  
Reverse Remodelling ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Lv Systolic Function ◽  
Group 1

Abstract Background Left ventricular (LV) strain has prognostic utility following ST-elevation myocardial infarction (STEMI); however, serial changes in LV strain has not been evaluated post-infarct. We sought to determine the relationship between post-STEMI transthoracic echocardiographic (TTE) LV global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) imaging derived scar size and LV systolic remodelling. Methods Following revascularisation, 172 first STEMI patients (85% male, 56.9±10.7 years) had paired TTE for GLS, and CMR to evaluate scar size and LV systolic function at baseline (2–7 days) and follow-up (8–10 weeks). Patients were divided into 3 groups according to absolute baseline GLS: group 1 (GLS ≥16%), group 2 (12%< GLS <16%), group 3 (GLS ≤12%). GLS recovery was defined as ≥10% increase in GLS at follow-up, excluding patients with normal baseline GLS. LV systolic adverse remodelling was defined as ≥15% increase in LVESV. LV systolic reverse remodelling was defined as ≥15% decrease in LVESV. Scar reduction was defined as ≥30% decrease in scar size. Results Group 1 and 2 had smaller follow-up scar size and higher LVEF compared to group 3 (p<0.0001 for both, see table). There was no difference in scar size reduction or systolic reverse remodeling among the baseline GLS groups (p>0.05 for both). Importantly, no patients from group 1 demonstrated systolic adverse remodelling. Relative change in GLS is significantly correlated with changes in LVEF (r=0.354, p<0.0001) and scar size (r=−0.262, p<0.0001), see figure. On multivariate binary logistic analysis, patients who demonstrated GLS recovery had greater reduction in scar size (OR=2.77 (1.09–7.01), p=0.032) and LV systolic reverse remodelling (OR=9.63 (1.21–76.41), p=0.032). Follow-up parameters within GLS groups All patients (n=172) Group 1 (n=47) Group 2 (n=72) Group 3 (n=53) Follow-up GLS, % 16.02±3.44 19.38±1.90 16.36±2.09 12.57±2.69 GLS recovery, n 110 (64%) 19 (40%) 53 (74%) 38 (72%) Follow-up scar size, % 7.67±5.40 5.01±3.38 6.27±3.73 12.02±6.24 Follow-up LVEF, % 51.80±10.20 57.83±6.95 54.14±8.02 43.26±9.83 Data presented as mean ± SD or n (%). Correlation graphs for change in GLS Conclusion Stratification of STEMI patients by baseline GLS was a determinant of CMR scar size as well as LV systolic function. However, the evaluation of GLS recovery could provide additional insights into reduction in scar size and LV systolic remodelling, both important prognostic markers. Thus, echocardiographic serial GLS evaluation may be a relevant non-invasive parameter, that is cheaper and more widely available for monitoring STEMI patients and guiding therapy.

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