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.
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.
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.
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.
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.
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。
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。
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）。
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。
