Left ventricular global longitudinal strain and long-term prognosis in patients with chronic obstructive pulmonary disease after acute myocardial infarction

Abstract

Left ventricular (LV) systolic function is a known prognostic factor after ST-segment elevation myocardial infarction (STEMI). We evaluated the prognostic value of LV global longitudinal strain (GLS) in patients with chronic obstructive pulmonary disease (COPD) after STEMI. One hundred and forty-three STEMI patients with COPD (mean age 70 ± 11 years, 71% male), were retrospectively analysed. Left ventricular ejection fraction (LVEF) and LV GLS were measured on transthoracic echocardiography within 48 h of admission. Patients were followed for the occurrence of all-cause mortality and the combined endpoint of all-cause mortality and heart failure hospitalization. After a median follow-up of 68 (interquartile range 38.5-99) months, 66 (46%) patients died and 70 (49%) patients reached the combined endpoint. The median LV GLS was -14.4%. Patients with LV GLS >-14.4% (more impaired) showed higher cumulative event rates of all-cause mortality (19%, 26%, and 44% vs. 7%, 8%, and 18% at 1, 2, and 5 years follow-up; log-rank P = 0.004) and the combined endpoint (26%, 34%, and 50% vs. 8%, 10%, and 20% at 1, 2, and 5 years follow-up; log-rank P = 0.001) as compared to patients with LV GLS ≤-14.4%. In multivariate analysis, LV GLS >-14.4% was independently associated with increased all-cause mortality and the combined endpoint [hazard ratio (HR) 2.07; P = 0.02 and HR 2.20; P = 0.01, respectively] and had incremental prognostic value over LVEF demonstrated by a significant increase in χ2 (P = 0.023 and P = 0.011, respectively). Impaired LV GLS is independently associated with worse long-term survival in STEMI patients with COPD and has incremental prognostic value over LVEF.