Bendary Ahmed, Tawfeek Wael, Mahros Mohammed, Salem Mohamed
Benha Faculty of Medicine, Cardiology Department, Benha University, Benha, Egypt.
Echocardiography. 2018 Jul;35(7):915-921. doi: 10.1111/echo.13866. Epub 2018 Mar 22.
Left ventricular ejection fraction (LVEF) is fundamental for risk stratification after ST-segment elevation myocardial infarction (STEMI). However, it lacks discrimination power within normal range. Novel echocardiographic deformation parameters may be of benefit for those with post-MI preserved LVEF.
We hypothesized that semiautomated calculation of baseline global longitudinal strain (GLS) can identify high-risk group among patients with LVEF ≥ 50% following STEMI.
During the period from January to July 2017, 110 patients with successful reperfusion of STEMI and LVEF ≥ 50% were prospectively included. Within 48 hours, patients underwent a baseline GLS study with follow-up study at 30 days. The endpoint was a composite of cardiovascular mortality, rehospitalization for heart failure, and urgent revascularization.
Mean GLS value changed from -16 ± 4% at baseline to -12 ± 4% at 30-day follow-up (P < .001). At 30 days, cardiovascular mortality was reported in 4.5%, 11.8% were rehospitalized due to heart failure, and 5.4% underwent urgent revascularization. ROC curve analysis showed that a cutoff baseline GLS value >-12.65% predicted 30-day MACEs with a sensitivity and specificity of 77.8% and 83.7%, respectively (AUC 0.784, 95% CI 0.646-0.921, P < .001). An adjusted multivariate logistic regression analysis revealed that baseline GLS value >-12.65% to be the only significant independent predictor for occurrence of MACEs (OR 19.54, 95% CI 6.3-61.1, P < .001).
Early GLS calculation predicts 30-day outcome in patients with preserved LVEF following reperfusion of STEMI.
左心室射血分数（LVEF）是ST段抬高型心肌梗死（STEMI）后风险分层的基础。然而，它在正常范围内缺乏鉴别能力。新型超声心动图变形参数可能对心肌梗死后LVEF保留的患者有益。
我们假设，半自动计算基线整体纵向应变（GLS）可以识别STEMI后LVEF≥50%的患者中的高危组。
在2017年1月至7月期间，前瞻性纳入110例STEMI成功再灌注且LVEF≥50%的患者。在48小时内，患者接受基线GLS研究，并在30天时进行随访研究。终点是心血管死亡、因心力衰竭再次住院和紧急血运重建的复合终点。
平均GLS值从基线时的-16±4%变为30天随访时的-12±4%（P<.001）。在30天时，报告心血管死亡率为4.5%，11.8%因心力衰竭再次住院，5.4%接受紧急血运重建。ROC曲线分析显示，基线GLS值>-12.65%预测30天主要不良心血管事件的敏感性和特异性分别为77.8%和83.7%（AUC 0.784，95%CI 0.646-0.921，P<.001）。调整后的多因素逻辑回归分析显示，基线GLS值>-12.65%是发生主要不良心血管事件的唯一显著独立预测因素（OR 19.54，95%CI 6.3-61.1，P<.001）。
早期计算GLS可预测STEMI再灌注后LVEF保留患者的30天预后。
