Prognostic Implications of Global Longitudinal Strain by Feature-Tracking Cardiac Magnetic Resonance in ST-Elevation Myocardial Infarction

Abstract

Background: The high accuracy of feature-tracking cardiac magnetic resonance (CMR) imaging qualifies this novel modality as potential gold standard for myocardial strain analyses in ST-elevation myocardial infarction patients; however, the incremental prognostic validity of feature-tracking-CMR over left ventricular ejection fraction (LVEF) and myocardial damage remains unclear. This study therefore aimed to determine the value of myocardial strain measured by feature-tracking-CMR for the prediction of clinical outcome following ST-elevation myocardial infarction. Methods: This prospective observational study enrolled 451 revascularized ST-elevation myocardial infarction patients. Comprehensive CMR investigations were performed 3 (interquartile range, 2–4) days after infarction to determine LVEF, global longitudinal strain (GLS), global radial strain, and global circumferential strain as well as myocardial damage. Primary end point was a composite of death, re-infarction, and congestive heart failure (major adverse cardiac events [MACE]). Results: During a follow-up of 24 (interquartile range, 11–48) months, 46 patients (10%) experienced a MACE event. All 3 strain indices were impaired in patients with MACE (all P <0.001). However, GLS emerged as the strongest MACE prognosticator among strain parameters (area under the curve, 0.73 [95% CI, 0.69–0.77]) and was significantly better ( P =0.005) than LVEF (area under the curve, 0.64 [95% CI, 0.59–0.68]). The association between GLS and MACE remained significant ( P <0.001) after adjustment for global radial strain, global circumferential strain, and LVEF as well as for infarct size and microvascular obstruction. The addition of GLS to a risk model comprising LVEF, infarct size, and microvascular obstruction led to a net reclassification improvement (0.35 [95% CI, 0.14–0.55]; P <0.001). Conclusions: GLS by feature-tracking-CMR strongly and independently predicted the occurrence of medium-term MACE in contemporary revascularized ST-elevation myocardial infarction patients. Importantly, the prognostic value of GLS was superior and incremental to LVEF and CMR markers of infarct severity.

Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST‐segment elevation myocardial infarction (STEMI)

“…This was similar to Reindl et al 25 who studied prognostic implications of global longitudinal strain by feature‐tracking cardiac magnetic resonance in ST‐elevation myocardial infarction and found that there was association between GLS derived by CMR and MACE ( P < .001) after adjustment for global radial strain, global circumferential strain, and LVEF as well as for infarct size and microvascular obstruction.…”

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

“…Moreover, a good correlation with infarct severity has been demonstrated [31]. All global strain parameters (global longitudinal, radial, and circumferential strain) derived from early CMR imaging after STEMI were shown to be of prognostic value in this setting [32,33]. In particular, global longitudinal strain was demonstrated to provide strong validity for the prediction of major adverse cardiovascular events (MACE) post-STEMI, incremental to LV ejection fraction and infarct severity markers [32].…”

“…All global strain parameters (global longitudinal, radial, and circumferential strain) derived from early CMR imaging after STEMI were shown to be of prognostic value in this setting [32,33]. In particular, global longitudinal strain was demonstrated to provide strong validity for the prediction of major adverse cardiovascular events (MACE) post-STEMI, incremental to LV ejection fraction and infarct severity markers [32]. Although the explanation for the crucial prognostic relevance of global longitudinal strain after infarction has not been entirely elucidated, this link most probably is based on the primarily longitudinal orientation of subendocardial myocardial fibers [26].…”

Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

“…The prognostic value of GLS has been reported in the literature, but is limited for multilayer strain. Earlier studies have shown superiority in predicting major adverse cardiac events compared to LVEF and CMR markers of infarct severity [ 3 , 24 ] in both STEMI and other cardiac disease states. Currently there is no consensus on defining cut-off values that correlate with hard endpoints, which are needed to facilitate informed clinical decision making.…”