The predictive value of global longitudinal strain on late infarct size in patients with anterior ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention.

Late infarct size (IS) after ST segment elevation myocardial infarction (STEMI) is a determinant of subsequent mortality. Late Gadolinium enhancement in cardiac magnetic resonance imaging (LGE-CMRI) is the gold standard for IS measurement, however, it is not readily accessible in many areas. We aimed to evaluate the value of early baseline 2D-echocardiographic global longitudinal strain (GLS) for the prediction of late IS after STEMI. From October 2017 to July 2018, we studied 100 patients with their 1st anterior STEMI treated with primary percutaneous coronary intervention. Baseline GLS calculation was performed within 48 h of admission. In addition, the average value of the nine segments supplied by the LAD was assessed separately (anterior GLS). Infarct size was assessed 3 months later using LGE-CMRI, and large infarcts were defined as ≥ 20% LV myocardium covered by scar. Based on CMRI, we defined two groups; 57 patients with large infarcts (group I) and 43 patients with small infarcts (group II). Both groups were matched in all baseline demographics and risk factors. There was a good and significant correlation between GLS and late IS (r = - 0.840, P < 0.001). This correlation was even higher for anterior GLS (r = - 0.867, P < 0.001). ROC analysis showed a cut-off point of GLS (- 13%) that identified large late IS with a sensitivity and specificity of 66.7% and 88.4% respectively (AUC = 0.85). For anterior GLS, the cut-off point was - 9.6% (Sensitivity 94%, specificity 86%, AUC = 0.9). We concluded that baseline GLS significantly predicts late IS after anterior STEMI.

Impact of ST-segment resolution on clinical outcome in patients with ST-segment elevation myocardial infarction and preserved left ventricular function.

BACKGROUND: Patients with successful reperfusion and preserved left ventricular ejection fraction (LVEF) after ST-segment myocardial infarction (STEMI)have always been thought to have low risk for adverse events. Great interest is focused on finding simple, noninvasive tools to refine risk stratification among them. OBJECTIVES: We hypothesized that degree of ST-segment resolution (STR) after STEMI can identify high-risk group among patients with LVEF ≥ 50% following STEMI. METHODS: During the period from January to July 2017, patients with successful reperfusion of STEMI and LVEF ≥ 50% were prospectively included. Patients were divided into two groups based on the percent of ST segment resolution using single lead STR method; group I (complete STR ≥ 70%) and group II (partial STR 50%-70%). The endpoint was a composite of cardiovascular mortality, re-hospitalization for heart failure and urgent revascularization at 30-day. RESULTS: After exclusion, 110 patients were left for final analysis. No significant differences in all baseline characteristics were found between both groups. The primary endpoint occurred in seven patients (12.7%) of group I versus 17 patients (30.9%) of group II (Relative risk = 2.43, 95%CI = 1.1-5.4, p = 0.021) driven by a significant reduction in rates of re-hospitalization due to heart failure. A multivariate logistic regression analysis showed incomplete STR to be a significant independent predictor for 30-dayMACEs (OR 3.25, 95% CI1.2-8.83, p = 0.02) even after adjustment for location of infarction. CONCLUSION: Complete STR predicts 30-day outcome in patients with preserved LVEF following successful reperfusion of STEMI.