Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters

被引：26

作者：

Holzknecht, Magdalena ^{[1
]}

Reindl, Martin ^{[1
]}

Tiller, Christina ^{[1
]}

Reinstadler, Sebastian J. ^{[1
]}

Lechner, Ivan ^{[1
]}

Pamminger, Mathias ^{[2
]}

Schwaiger, Johannes P. ^{[3
]}

Klug, Gert ^{[1
]}

Bauer, Axel ^{[1
]}

Metzler, Bernhard ^{[1
]}

Mayr, Agnes ^{[2
]}

机构：

[1] Med Univ Innsbruck, Univ Clin Internal Med Cardiol & Angiol 3, Anichstr 35, A-6020 Innsbruck, Austria

[2] Med Univ Innsbruck, Univ Clin Radiol, Anichstr 35, A-6020 Innsbruck, Austria

[3] Acad Teaching Hosp Hall In Tirol, Dept Internal Med, Milser Str 10, A-6060 Hall In Tirol, Austria

来源：

CLINICAL RESEARCH IN CARDIOLOGY | 2021年 / 110卷 / 10期

基金：

奥地利科学基金会;

关键词：

ST-segment elevation myocardial infarction; Cardiac magnetic resonance imaging; Left ventricular function; Myocardial strain; Prognosis; CARDIOVASCULAR MAGNETIC-RESONANCE; LONG AXIS STRAIN; HEART-FAILURE; ECHOCARDIOGRAPHY; STRATIFICATION; STANDARD;

D O I：

10.1007/s00392-021-01855-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aim We aimed to investigate the comparative prognostic value of left ventricular ejection fraction (LVEF), mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by cardiac magnetic resonance (CMR) in patients after ST-segment elevation myocardial infarction (STEMI). Methods and results This observational cohort study 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 left ventricular (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. During a follow-up of 16 [IQR: 12-49] months, 48 (11%) patients experienced a MACE. LVEF (p = 0.023), MAPSE (p < 0.001), LAS (p < 0.001) and GLS (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): 1.13, 95% CI 1.01-1.27; p = 0.030), as well as angiographical (HR: 1.13, 95% CI 1.01-1.28; p = 0.037) and clinical parameters (HR: 1.16, 95% CI 1.05-1.29; p = 0.003). Conclusion GLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as angiographical and clinical characteristics with superior prognostic validity compared to LVEF. [GRAPHICS] .

引用

页码：1599 / 1611

页数：13

共 45 条

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