The predictive value of global longitudinal strain on clinical outcome in patients with ST-segment elevation myocardial infarction and preserved systolic function.

Abstract

Left ventricular ejection fraction (LVEF) is fundamental for risk stratification after ST-segment elevation myocardial infarction (STEMI). However, it lacks discrimination power within normal range. Novel echocardiographic deformation parameters may be of benefit for those with post-MI preserved LVEF. We hypothesized that semiautomated calculation of baseline global longitudinal strain (GLS) can identify high-risk group among patients with LVEF≥50% following STEMI. During the period from January to July 2017, 110 patients with successful reperfusion of STEMI and LVEF≥50% were prospectively included. Within 48hours, patients underwent a baseline GLS study with follow-up study at 30days. The endpoint was a composite of cardiovascular mortality, rehospitalization for heart failure, and urgent revascularization. Mean GLS value changed from -16±4% at baseline to -12±4% at 30-day follow-up (P<.001). At 30days, cardiovascular mortality was reported in 4.5%, 11.8% were rehospitalized due to heart failure, and 5.4% underwent urgent revascularization. ROC curve analysis showed that a cutoff baseline GLS value >-12.65% predicted 30-day MACEs with a sensitivity and specificity of 77.8% and 83.7%, respectively (AUC 0.784, 95% CI 0.646-0.921, P<.001). An adjusted multivariate logistic regression analysis revealed that baseline GLS value >-12.65% to be the only significant independent predictor for occurrence of MACEs (OR 19.54, 95% CI 6.3-61.1, P<.001). Early GLS calculation predicts 30-day outcome in patients with preserved LVEF following reperfusion of STEMI.