Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction

• Published in: Journal of the American College of Cardiology Vol. 61; no. 23; pp. 2365 - 2373
• Main Authors: Ersbøll, Mads, Valeur, Nana, Mogensen, Ulrik Madvig, Andersen, Mads Jønsson, Møller, Jacob Eifer, Velazquez, Eric J., Hassager, Christian, Søgaard, Peter, Køber, Lars
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 11.06.2013; Elsevier Limited
• Subjects: acute myocardial infarction; Aged; Cardiology; Cardiovascular; cardiovascular outcomes; Cause of Death; Cohort Studies; Confidence Intervals; Coronary vessels; Echocardiography, Doppler; Female; Heart attacks; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; heart failure; Hospitalization; Humans; longitudinal strain; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Predictive Value of Tests; preserved LV function; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Severity of Illness Index; Stroke Volume - physiology; Survival Rate; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; eGFR; cardiovascular outcomes; NRI; WMSI; LVMI; MR; CI; LVEF; preserved LV function; HR; LV; LAVi; GLS; IDI; longitudinal strain; heart failure; STEMI; MI; acute myocardial infarction; HF; left atrial volume index; estimated glomerular filtration rate; integrated diagnostic improvement; myocardial infarction; left ventricular mass index; left ventricular ejection fraction; left ventricular; heart failure; mitral regurgitation; net reclassification index; wall motion score index; global longitudinal strain; hazard ratio; confidence interval; ST-segment elevation myocardial infarction
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2013.02.061

This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%. LVEF is a key determinant in decision making after acute MI, yet it is relatively indiscriminant within the normal range. Novel echocardiographic deformation parameters may be of particular clinical relevance in patients with relatively preserved LVEFs. Patients with MIs and LVEFs >40% within 48 h of admission for coronary angiography were prospectively included. All patients underwent echocardiography with semiautomated measurement of GLS. The primary composite endpoint (all-cause mortality and hospitalization for heart failure) was analyzed using Cox regression analyses. The secondary endpoints were cardiac death and heart failure hospitalization. A total of 849 patients (mean age 61.9 ± 12.0 years, 73% men) were included, and 57 (6.7%) reached the primary endpoint (median follow-up 30 months). Significant prognostic value was found for GLS (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.10 to 1.32; p < 0.001). GLS > −14% was associated with a 3-fold increase in risk for the combined endpoint (HR: 3.21; 95% CI: 1.82 to 5.67; p < 0.001). After adjustment for other variables, GLS remained independently related to the combined endpoint (HR: 1.14; 95% CI: 1.04 to 1.26; p = 0.007). For the secondary endpoints, GLS > −14% was significantly associated with cardiovascular death (HR: 12.7; 95% CI: 3.0 to 54.6; p < 0.001) and heart failure hospitalization (HR: 5.31; 95% CI: 1.50 to 18.82; p < 0.001). Assessment of GLS using a semiautomated algorithm provides important prognostic information in patients with LVEFs >40% above and beyond traditional indexes of high-risk MI.