Abstract 16744: Global Two-Dimensional Strain as a New Prognostic Factor in Patients With Reperfused Acute Stemi
Objectives: We sought to evaluate whether global 2-dimensional (2D) strain offers additional benefit over left ventricular ejection fraction (LVEF) to predict clinical events in successfully reperfused acute STEMI (ST elevation myocardial infarction) patients.
Methods: Total 604 patients (age 59±13, 20% female) admitted for STEMI and who received successful reperfusion therapy, underwent clinical evaluation and conventional and tissue Doppler echocardiography. Using dedicated software, global longitudinal strain (GLS) in apical 4-, 3- and 2-chamber views and global circumferential strain (GCS) in a parasternal short-axis apical, mid and basal view were measured. Patients with cardiogenic shock (IABP or ECMO support) or revascularized after 12 hours from onset time were excluded from analysis.
Results: During a follow-up 25±19 months, there were 15 (2.5%) clinical events, including cardiac death or hear failure hospitalization. In univariate analysis, age, hypertension, left ventricular ejection fraction (LVEF), E/E’, as well as both GLS and GCS were predictive of clinical events. In multivariate Cox models, age (hazard ratio [HR]: 1.08, p=0.048), LVEF (HR: 0.94, p<0.001), GLS (HR: 0.51, p<0.001), and GCS (HR: 0.087, p=0.003) were independent predictors. With regard to the incremental value, GLS or GCS offers additional benefits over LVEF (global chi-square of LVEF=16.1, LVEF+GCS=19.3, LVEF+GLS=22.1 and EFLVEF+GLS+GCS=24.4). Based on the results of the ROC curve, GCS, GLS, and LVEF cutoff was each -9.6%, -9.6%, and 40%, respectively. It provides asensitivity of 87%, 83%, and 88% and a specificity of 75%, 99%, 67% to predict future events. The incidence of events was significantly higher in patients with GCS>-9.6%, GLS>-9.6%, or LVEF<40% in Kaplan-Meier analysis.
Conclusions: GLS and GCS are powerful predictors of clinical events and appears to be a better parameter than ejection fraction in successfully reperfused STEMI patients.
- © 2013 by American Heart Association, Inc.