Abstract
Background: The impact of concomitant impairments of left and right ventricular (LV and RV) strain on the long-term prognosis of acute ST-elevation myocardial infarction (STEMI) is not clear.Methods: We analyzed CMR images and followed up 420 first STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453). These patients received timely primary percutaneous coronary intervention (PCI) within 12 h and CMR examination within 1 week (median, 5 days; range, 2–7 days) after infarction. Global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) of both ventricles were measured based on CMR cine images. Conventional CMR indexes were also assessed. Primary clinical outcome was composite major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, re-hospitalization for heart failure and stroke. In addition, CMR data from 40 people without apparent heart disease were used as control group.Results: Compared to controls, both LV and RV strains were remarkably reduced in STEMI patients. During follow-up (median: 52 months, interquartile range: 29–68 months), 80 patients experienced major adverse cardiac and cerebrovascular events (MACCEs) including cardiovascular death, re-infarction, heart failure, and stroke. LV-GCS > −11.20% was an independent predictor of MACCEs (P < 0.001). RV-GRS was the only RV strain index that could effectively predict the risk of MACCEs (AUC = 0.604, 95% CI [0.533, 0.674], P = 0.004). Patient with RV-GRS ≤ 38.79% experienced more MACCEs than those with preserved RV-GRS (log rank P < 0.001). Moreover, patients with the concomitant decrease of LV-GCS and RV-GRS were more likely to experience MACCEs than patients with decreased LV-GCS alone (log rank P = 0.010). RV-GRS was incremental to LV-GCS for the predictive power of MACCEs (continuous NRI: 0.327; 95% CI: 0.095–0.558; P = 0.006). Finally, tobacco use (P = 0.003), right coronary artery involvement (P = 0.002), and LV-GCS > −11.20% (P = 0.012) was correlated with lower RV-GRS.Conclusions: The concomitant decrease of LV and RV strain is associated with a worse long-term prognosis than impaired LV strain alone. Combination assessment of both LV and RV strain indexes could improve risk stratification of patients with STEMI.Trial Registration: ClinicalTrials.gov, NCT03768453. Registered 7 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03768453.
Highlights
The in-hospital mortality rate of patients with acute STelevation myocardial infarction (STEMI) has greatly declined [1]
Recent studies have shown that the impairments of left ventricle (LV) strains measured by echocardiography and cardiac magnetic resonance (CMR) in the acute phase of STEMI are closely related to future LV remodeling, sustained deterioration of LV ejection fraction (LVEF), and the occurrence of adverse events [4,5,6]
We found that post-STEMI LV strain is a key determinant of patient prognosis and that LV-GCS > −11.20% in the acute phase of STEMI is an independent predictor of long-term major adverse cardiac and cerebrovascular events (MACCEs)
Summary
The in-hospital mortality rate of patients with acute STelevation myocardial infarction (STEMI) has greatly declined [1]. LV ejection fraction (LVEF) is regularly used as a measurement of LV function, it is less sensitive for the detection of regional or subtle myocardial impairments, which are common in the early phase of myocardial infarction and occur as the very beginning of subsequent adverse cardiac remodeling [3]. Recent studies have shown that the impairments of LV strains measured by echocardiography and cardiac magnetic resonance (CMR) in the acute phase of STEMI are closely related to future LV remodeling, sustained deterioration of LVEF, and the occurrence of adverse events [4,5,6]. The impact of concomitant impairments of left and right ventricular (LV and RV) strain on the long-term prognosis of acute ST-elevation myocardial infarction (STEMI) is not clear
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