Abstract 732 Comprehensive global longitudinal strain assessment and mortality after acute myocardial infarction

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Comprehensive global longitudinal strain assessment and mortality after acute myocardial infarction – the ECAD registry
V. Backmann¹, I. Dykun¹, S. Hendricks¹, F. Al-Rashid¹, M. Totzeck¹, T. Rassaf¹, A.-A. Mahabadi¹
¹Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen;
Background: Current ESC-guidelines on the management of patients after acute myocardial infarction only include the assessment of left ventricular function by assessment of the ejection fraction in addition to clinical risk scores to estimate the patient’s prognosis. We aimed to determine, whether a comprehensive global longitudinal strain (GLS) assessment of left ventricular (LV), left atrial (LA), and right ventricular (RV) function would associate with long-term survival in patients after myocardial infarction Methods: The present analysis is based on the longitudinal ECAD registry of consecutive patients undergoing coronary angiography at the West German Heart and Vascular Center between 2004 and 2019. For this analysis, we included patients with the primary discharge diagnosis of myocardial infarction (ST-elevation myocardial infarction or non-ST-elevation myocardial infarction) and available transthoracic echocardiography imaging of sufficient quality for assessment of GLS. Patients with missing follow-up information were excluded. Assessment of GLS was performed offline at a central core lab by dedicated study personnel using the TOMTEC- Arena 2D Cardiac Performance Analysis software. Cox regression analysis, adjusting for age, sex, systolic blood pressure, LDL-cholesterol, smoking status, diabetes, and family history of premature coronary artery disease was performed. In ancillary models, LV ejection fraction, LA index or TAPSE were added. Hazard ratios and 95% confidence intervals are depicted per 1 standard deviation increase in GLS measure. Results: Overall, data from 1409 patients (64.4±13.5 years, 24.7% female) were included for the present analysis. Median time between index procedure and echocardiography was 4 (2; 13) days. During a follow-up of 2.8±3.1 years, 157 (11.1%) patients died. Patients that died had on average poorer LV-GLS (-12.8±5.4 vs. -15.7±5.2%, p<0.0001), LA-GLS (15.4±8.0 vs. 21.1±9.1%, p<0.0001), and RV-GLS (-16.0±5.6 vs. -18.3±5.4%, p<0.0001, for patients with vs. without mortality, respectively). In multivariable Cox regression analysis, LV-GLS (1.69 [1.38-2.08], p<0.0001), LA-GLS (0.58 [0.48-0.70], p<0.0001), and RV-GLS (1.39 [1.15-1.67], p=0.0005) were associated with long-term mortality. Simultaneously adding LV-GLS and LV-EF into one model, only LV-GLS remained statistically significant (1.45 [1.09-1.94], p=0.012), while LV-EF did no longer show an independent link with mortality (0.82 [0.62-1.07], p=0.15). In contrast, both LA-GLS and LA index within one model (LA-GLS: 0.59 [0.48-0.74], p<0.0001; LA index: 1.19 [1.02-1.40], p=0.029) as well as RV-GLS and TAPSE (RV-GLS: 1.42 [1.003-2.01], p=0.048; TAPSE: 0.68 [0.49-0.96], p=0.026) remained significantly associated. Conclusion: Global longitudinal strain assessments of LV, LA and RV function associate with survival after myocardial infarction, independent of traditional cardiovascular risk factors and established measures of cardiac chamber sizes and function.
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