Background: Current ESC-guidelines on the management of patients after acute myocardial infarction include the echocardiographic evaluation of left ventricular function by assessment of the left ventricular ejection fraction in addition to clinical risk scores to estimate the patient’s prognosis, irrespective of area of the myocardial infarction. In this analysis on patients with posterior wall myocardial infarction, we aimed to determine, whether the global longitudinal strain (GLS) assessment of right ventricular (RV) function as well as left ventricular (LV) function would associate with long-term survival.

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 experiencing posterior wall myocardial infarction, defined as the culprit vessel being in the right coronary artery (RCA) or – in case of left dominant circulation – in the left circumflex artery (CX). Only cases with available echocardiography imaging with sufficient quality for assessment of GLS were included, while 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 and sex was performed. Hazard ratios and 95% confidence intervals are depicted per 1 standard deviation increase in GLS measure / LV ejection fraction.

Results: Overall, data from 391 patients (65.1±13.0 years, 27.6% female) were included for the present analysis. Median time between index procedure and echocardiography was 4 (2; 12) days. During a follow-up of 2.7±3.4 years, 49 (12.5%) patients died. Patients that died had on average poorer LV ejection fraction (43.4±13.6% vs. 51.5±10.8%, p=0.0007) and LV-GLS (-13.1±6.11% vs. -16.9±4.61%, p=0.0163), whereas RV-GLS was not significantly different for non-survivors vs. survivors (RV-GLS -16.7±4.12% vs. -18.4±4.93%, p=0.08, for patients with vs. without mortality, respectively). In multivariable Cox regression analysis, LV-GLS (1.77 [1.16 - 2.69], p=0.008) and LV ejection fraction (0.63 [0.48-0.84], p= 0.002) were associated with long-term mortality. In contrast, lower RV-GLS was not significantly linked with increased long-term mortality (1.38 [0.90-2.12], p=0.14).

Conclusion: In patients with posterior wall myocardial infarction, global longitudinal strain assessment of LV function in addition to LV ejection fraction associates with survival. In contrast, RV-GLS does not qualify for detection of patients with increased mortality risk.