Abstract 366 Global Longitudinal Strain Improves Risk Assessment After ST-Segment Elevation Myocardial Infarction: A Comparative Prognostic Evaluation of Left Ventricular Functional Parameters

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Global Longitudinal Strain Improves Risk Assessment After ST-Segment Elevation Myocardial Infarction: A Comparative Prognostic Evaluation of Left Ventricular Functional Parameters
M. Holzknecht¹, M. Reindl¹, C. Tiller¹, S. J. Reinstadler¹, I. Lechner¹, M. Pamminger², J. Schwaiger³, G. Klug¹, A. Bauer¹, A. Mayr², B. Metzler¹
¹Univ.-Klinik für Innere Medizin III, Kardiologie und Angiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich; ²Univ.-Klinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, AT; ³Department für Innere Medizin, Landeskrankenhaus Hall, Hall in Tirol, AT;
Background: The prognostic value of left ventricular ejection fraction (LVEF) in patients with ST-segment elevation myocardial infarction (STEMI) is known to be limited. However, comprehensive investigations comparing different cardiac magnetic resonance (CMR) derived left ventricular (LV) function parameters to predict hard clinical events following STEMI are lacking so far. We aimed to investigate the comparative prognostic value of LVEF, mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by CMR in patients after acute STEMI. Methods: This observational cohort study (NCT04113356) 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 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. Results: During a follow-up of 15 [IQR: 12-48] months, 48 (11%) patients experienced a MACE. LVEF (50% vs. 53%, p=0.023), MAPSE (8.0 mm vs. 9.1 mm, p<0.001), LAS (-11.2% vs. -15.2%, p<0.001) and GLS (-10.6% vs. -12.3%, 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): 1.23, 95% CI 1.01-1.26; p=0.036), as well as clinical parameters (HR: 1.16, 95% CI 1.05-1.28; p=0.004). Conclusions: GLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as clinical characteristics with superior prognostic validity compared to LVEF.
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