title: Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  Global longitudinal systolic strain (GLS) has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI). The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information.
  
  
  METHODS
  In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI) and two-dimensional strain echocardiography (2DSE).
  
  
  RESULTS
  During a median-follow-up of 5.3 (IQR 2.5-6.1) years the primary endpoint (death, heart failure or a new MI) was reached by 145 (38.9%) patients. After adjustment for significant confounders (including conventional echocardiographic parameters) and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS) remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032). In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p<0.05 for all deformation parameters).
  
  
  CONCLUSIONS
  Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.|Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tor
authors.identifier: http://orcid.org/0000-0003-4209-2778
authors.initials: T
authors.lastname: Biering-Sørensen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.|Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Sune H
authors.initials: SH
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Bech
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Flemming Javier
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy