Prognostic power of global 2D strain according to left ventricular ejection fraction in patients with ST elevation myocardial infarction.
BACKGROUND
We aimed to evaluate the predictive power of longitudinal and circumferential fibers according to left ventricular ejection fraction (LVEF) in successfully reperfused acute ST elevation myocardial infarction (STEMI) patients.


METHODS
Total 691 patients (age 59±13, 20% female) underwent clinical evaluation and conventional and strain echocardiography (Global longitudinal strain (GLS), global circumferential strain (GCS)). The clinical outcome was defined as the composite of death, hospitalization for heart failure, non-fatal myocardial infarction, and ventricular arrhythmia.


RESULTS
During a follow-up of 39±19 months, there were 47 (6.8%) clinical events. In multivariate Cox models adjusted clinical risk factors, age (HR 1.08, p = 0.001) and GLS (HR 1.37, p = 0.001) were independent predictors. The addition of GLS resulted in significant incremental improvement in the predictive value on LVEF (χ2 = 31.8→45.8, p<0.001), although GCS offers no additional benefit. In the subgroup analysis according to LVEF, adjusted with clinical factors, GLS was significant predictive for outcome for the patients with mildly depressed (LVEF 40-50%, HR 2.25, p<0.001) and significantly depressed (LVEF<40%, HR 1.28, p = 0.016) systolic function, although GCS and LVEF lost their power with LVEF<40%. For the patients with preserved LVEF (>50%), GLS, GCS and LVEF did not show significant predictive power.


CONCLUSIONS
GLS is a most powerful predictor of outcome in successfully reperfused STEMI patients, especially with depressed LV dysfunction, although GCS and LVEF lost their predictive power for the patients with significantly depressed LV function. However, GLS did not predict outcome for the patients with preserved LVEF (>50%).
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Myung-Jin
MJ
Cha
Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Anyang, South Korea.
Hyun-Sook
HS
Kim
Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Anam, South Korea.
Seong Hwan
SH
Kim
Cardiovascular Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea.
Jae-Hyeong
JH
Park
Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Goo-Yeong
http://orcid.org/0000-0002-7067-5535
GY
Cho
D000367:Age Factors; D000368:Aged; D004452:Echocardiography / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*