Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Latvian Cardiology Center, Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Residency, Riga Stradins University, Riga, Latvia.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Am Soc Echocardiogr. 2024 Jul;37(7):666-673. doi: 10.1016/j.echo.2024.03.007. Epub 2024 Mar 19.
INTRODUCTION: After ST-segment elevation myocardial infarction (STEMI), follow-up imaging is currently recommended only in patients with left ventricular ejection fraction (LVEF) <40%. Left ventricular global longitudinal strain (LVGLS) was shown to improve risk stratification over LVEF in these patients but has not been thoroughly studied during follow-up. The aim of this study was to explore the changes in LVGLS after STEMI and their potential prognostic value. MATERIALS AND METHODS: Data were analyzed from an ongoing STEMI registry. Echocardiography was performed during the index hospitalization and 1 year after STEMI; LVGLS was expressed as an absolute value and the relative LVGLS change (ΔGLS) was calculated. The study end point was all-cause mortality. RESULTS: A total of 1,409 STEMI patients (age 60 ± 11 years; 75% men) who survived at least 1 year after STEMI and underwent echocardiography at follow-up were included. At 1-year follow-up, LVEF improved from 50% ± 8% to 53% ± 8% (P < .001) and LVGLS from 14% ± 4% to 16% ± 3% (P < .001). Median ΔGLS was 14% (interquartile range, 0.5%-32%) relative improvement. Starting 1 year after STEMI, a total of 87 patients died after a median follow-up of 69 (interquartile range, 38-103) months. The optimal ΔGLS threshold associated with the end point (derived by spline curve analysis) was a relative decrease >7%. Cumulative 10-year survival was 91% in patients with ΔGLS improvement or a nonsignificant decrease, versus 85% in patients with ΔGLS decrease of >7% (P = .001). On multivariate Cox regression analysis, ΔGLS decrease >7% remained independently associated with the end point (hazard ratio, 2.5 [95% CI, 1.5-4.1]; P < .001) after adjustment for clinical and echocardiographic parameters. CONCLUSIONS: A significant decrease in LVGLS 1 year after STEMI was independently associated with long-term all-cause mortality and might help further risk stratification and management of these patients during follow-up.
简介：在 ST 段抬高型心肌梗死（STEMI）后，目前仅建议左心室射血分数（LVEF）<40%的患者进行随访影像学检查。研究表明，左心室整体纵向应变（LVGLS）比 LVEF 更能改善这些患者的危险分层，但在随访期间尚未得到充分研究。本研究旨在探讨 STEMI 后 LVGLS 的变化及其潜在的预后价值。
材料与方法：本研究分析了一项正在进行的 STEMI 注册研究的数据。在 STEMI 住院期间和 STEMI 后 1 年进行了超声心动图检查；LVGLS 以绝对值表示，并计算相对 LVGLS 变化（ΔGLS）。研究终点为全因死亡率。
结果：共纳入 1409 例 STEMI 患者（年龄 60±11 岁；75%为男性），这些患者在 STEMI 后至少存活 1 年，并在随访时进行了超声心动图检查。在 1 年的随访中，LVEF 从 50%±8%改善至 53%±8%（P<0.001），LVGLS 从 14%±4%改善至 16%±3%（P<0.001）。中位数 ΔGLS 为 14%（四分位距，0.5%-32%），表示相对改善。从 STEMI 后 1 年开始，共有 87 例患者在中位随访 69（四分位距，38-103）个月后死亡。通过样条曲线分析得出与终点相关的最佳 ΔGLS 阈值为相对下降>7%。在 ΔGLS 改善或无显著下降的患者中，10 年累积生存率为 91%，而 ΔGLS 下降>7%的患者为 85%（P=0.001）。多变量 Cox 回归分析显示，在校正临床和超声心动图参数后，ΔGLS 下降>7%仍与终点独立相关（危险比，2.5[95%CI，1.5-4.1]；P<0.001）。
结论：STEMI 后 1 年 LVGLS 显著下降与长期全因死亡率独立相关，可能有助于在随访期间进一步对这些患者进行危险分层和管理。
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