Abstract
AimWe 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 resultsThis 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).ConclusionGLS 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
Highlights
Despite remarkable advances in the management of patients suffering from ST-segment elevation myocardial infarction (STEMI), the risk of subsequent cardiovascular complications and mortality post-STEMI still remains considerable [1]
global longitudinal strain (GLS) emerged as independent predictor of major adverse cardiac events (MACE) after adjustment for measures of left ventricular (LV) function (LVEF, mitral annular plane systolic excursion (MAPSE), long-axis strain (LAS)), myocardial injury (IS and MVO) angiographical and clinical parameters with superior prognostic validity compared to LV ejection fraction (LVEF)
We revealed Cardiac magnetic resonance (CMR) assessed MAPSE to independently predict the occurrence of hard clinical events with superior prognostic validity than LVEF following acute STEMI [9]
Summary
Despite remarkable advances in the management of patients suffering from ST-segment elevation myocardial infarction (STEMI), the risk of subsequent cardiovascular complications and mortality post-STEMI still remains considerable [1]. Remnant left ventricular (LV) function is a key determinant in decision-making after acute myocardial infarction and has a strong impact on short- and long-term prognosis [2]. Cardiac magnetic resonance (CMR) imaging represents the current gold standard to determine LV volumes and function and is the optimal imaging modality to evaluate subtle changes in the post-infarcted myocardium [4]. LV ejection fraction (LVEF) is a well-established marker of global LV function and recommended for risk prediction after STEMI with important implications for patient management [2, 5]. LVEF does not allow the assessment of subtle regional differences in cardiac function, hampering the prognostic accuracy of isolated LVEF assessment [6]
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