Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Int J Cardiovasc Imaging. 2015 Mar;31(3):575-84. doi: 10.1007/s10554-015-0593-2. Epub 2015 Jan 18.

Abstract

To determine whether left ventricular (LV) global longitudinal strain (GLS) predicts adverse LV remodeling and cardiac events. In a prospective cohort study of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), we recorded clinical data and GLS, global circumferential strain and radial strain using two-dimensional speckle-tracking echocardiography of the left ventricle. At 6-month and 3-year follow-ups, patients were grouped by presence or absence of adverse LV remodeling. We used logistic regression to identify factors associated with adverse LV remodeling and a Cox model to determine the relationships between these factors and cardiac events. Of 97 patients (mean age 56 ± 12 years; 76 men), 38 showed LV remodeling. Diabetes mellitus [odds ratio (OR) 1.95% confidence interval (CI) 1.2-4.8, p = 0.05], peak troponin I (OR 1.2, 95% CI 1.1-1.3, p = 0.004), and GLS (OR 1.6, 95% CI 1.3-2.3, p = 0.009) independently predicted LV remodeling. During follow-up (22.8 ± 12.3 months), 20 patients suffered adverse events, which were independently predicted by GLS alone (OR 4.9, 95% CI 1.7-13.9, p = 0.002). Optimal GLS cutoffs for predicting adverse LV remodeling and cardiac events were >-12.46% [area under receiver operating-characteristic curve (AUC) 0.88, 95% CI 0.79-0.96, p < 0.001] and >-9.27% (AUC 0.86, 95% CI 0.64-0.98, p < 0.001), respectively. GLS measured immediately after primary PCI is an excellent predictor of adverse LV remodeling and cardiac events in patients with AMI.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Chi-Square Distribution
  • Echocardiography, Doppler, Color
  • Echocardiography, Doppler, Pulsed
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Odds Ratio
  • Percutaneous Coronary Intervention / adverse effects*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Spain
  • Stress, Mechanical
  • Systole*
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left*
  • Ventricular Remodeling*