title: Left ventricular global longitudinal strain in acute myocardial infarction--with special reference to neurohormonal activation, in-hospital heart failure and prognosis.
abstract: BACKGROUND
  Systolic dysfunction, clinical heart failure and elevated levels of neurohormonal peptides are major predictors of adverse outcome after acute myocardial infarction (MI). In the present thesis we evaluated global longitudinal strain (GLS) in patients with acute MI in relation to neurohormonal activation, in-hospital heart failure and prognosis with specific attention to the group of patients with preserved LVEF that currently do not meet the criteria for anti remodeling therapies.
  
  
  RESULTS
  GLS was found to be significantly associated with neurohormonal activation as assessed by NT-proBNP levels and that this association was present also in patients with preserved LVEF. Patients with clinical HF during hospitalization for acute MI had significantly poorer GLS compared to controls and this relationship was robust when adjusting for known factors associated with elevated LV filling pressure such as left atrial volume and E/e' ratio. Furthermore, measurement of GLS attenuated the value of NT-proBNP in relation to in-hospital HF in patients with preserved LVEF. Finally, GLS was related to outcome in the largest ever echocardiographic deformation study of patients with acute MI and relatively preserved LVEF. We found that GLS predicted mortality and heart failure admissions and that the effect on mortality was driven by a significantly increased risk of cardiac death in patients with impaired GLS.
  
  
  CONCLUSIONS
  In conclusion, the results of this thesis demonstrate that GLS as a measure of LV systolic function is significantly related to elevated neurohormonal activation, early hemodynamic deterioration and predict adverse outcome in a low risk population without indications for anti remodeling therapies. Early measurement of GLS in this population could be used as a risk stratification tool for added monitoring and clinical trials.
authors.affiliation: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø. Denmark. mads.ersboell@gmail.com
authors.forename: Mads Kristian
authors.initials: MK
authors.lastname: Ersbøll
mesh_terms: D004562:Electrocardiography; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology*; D032383:Myocytes, Cardiac; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain