Prognostic Value of Follow-up Measures of Left Ventricular Global Longitudinal Strain in Patients With ST-Segment Elevation Myocardial Infarction

Laima Caunite; Rinchyenkhand Myagmardorj; Xavier Galloo; Dorien Laenens; Jan Stassen; Takeru Nabeta; Idit Yedidya; Maria C Meucci; Jurrien H Kuneman; Inge J van den Hoogen; Sophie E van Rosendael; Hoi Wai Wu; Victor M van den Brand; Adrian Giuca; Karlis Trusinskis; Pieter van der Bijl; Jeroen J Bax; Nina Ajmone Marsan

doi:10.1016/j.echo.2024.03.007

Prognostic Value of Follow-up Measures of Left Ventricular Global Longitudinal Strain in Patients With ST-Segment Elevation Myocardial Infarction

J Am Soc Echocardiogr. 2024 Mar 19:S0894-7317(24)00114-7. doi: 10.1016/j.echo.2024.03.007. Online ahead of print.

Authors

Laima Caunite¹, Rinchyenkhand Myagmardorj², Xavier Galloo³, Dorien Laenens², Jan Stassen⁴, Takeru Nabeta², Idit Yedidya⁵, Maria C Meucci⁶, Jurrien H Kuneman², Inge J van den Hoogen², Sophie E van Rosendael², Hoi Wai Wu², Victor M van den Brand², Adrian Giuca⁷, Karlis Trusinskis⁸, Pieter van der Bijl², Jeroen J Bax⁹, Nina Ajmone Marsan¹⁰

Affiliations

¹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Latvian Cardiology Center, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Residency, Riga Stradins University, Riga, Latvia.
² Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Ixelles, Belgium.
⁴ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
⁵ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Jaffa, Israel.
⁶ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁷ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Fundeni Clinical Institute, Bucharest, Romania; Department of Research Methodology, Craiova University of Medicine and Pharmacy, Craiova, Romania.
⁸ Latvian Cardiology Center, Pauls Stradins Clinical University Hospital, Riga, Latvia.
⁹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Centre, University of Turku and Turku University Hospital, Turku, Finland.
¹⁰ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: n.ajmone@lumc.nl.

PMID: 38513963
DOI: 10.1016/j.echo.2024.03.007

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.

Keywords: Left ventricular global longitudinal strain; ST-Segment elevation myocardial infarction.