Discharge left ventricular diastolic abnormalities and left atrial strain-to-volume ratio predict 6-month heart failure after STEMI
J Vratonjic, S Stankovic, G Krljanac, M Tomic, M Polovina, A Milosevic, L Djukanovic, D Jelic, Z Mehmedbegovic, D Lukic, T Pejovic, D Civric, M Asanin, G Stankovic, D Trifunovic ZamaklarAbstract
Background
Despite contemporary reperfusion therapy, a subset of STEMI patients develops heart failure (HF) during follow-up, including those with preserved or mildly reduced left ventricular ejection fraction (LVEF), suggesting mechanisms beyond global systolic dysfunction.
Purpose
To evaluate whether integrative assessment of LV diastolic function and the left atrial (LA) strain-to-volume ratio provides incremental prognostic value for 6-month HF beyond conventional and advanced systolic indices, including LVEF and global longitudinal strain (GLS).
Methods
We analyzed 472 consecutive STEMI patients from the prospective registry who underwent comprehensive discharge echocardiography and completed 6-month follow-up (61±12 years, 26% women, LVEF 48±9%). The composite 6-month HF endpoint (HF hospitalization, emergency visit for HF, or NYHA ≥II) occurred in 59 patients (12.5%). Assessed parameters included LVEF, GLS, global work efficiency (GWE), post-systolic shortening (PSD), septal E′, LA strain-to-volume ratio (PALS/LAV), and TRVmax. Two multivariable logistic models were constructed: Model A (septal E′, PALS/LAV, GWE, PSD, TRVmax) and Model B (septal E′ and PALS/LAV). Internal validation was performed using 1000-sample bootstrap resampling; discrimination was assessed by ROC analysis.
Results
In univariable analysis, septal E′ (OR 0.69, p<0.001), PALS/LAV (OR 0.04, p=0.001), PSD (OR 1.009 per ms, p=0.024), GWE (OR 0.96 per %, p=0.009), and TRVmax (OR 2.80, p=0.005) predicted 6-month HF, whereas LVEF and GLS showed modest discrimination (AUC 0.57 and 0.59). In multivariable analysis, only septal E′ and PALS/LAV remained independently associated with HF. Model A achieved AUC 0.72 (95% CI 0.63–0.81) and Model B 0.73 (95% CI 0.65–0.81). Model B outperformed LVEF (p=0.0287) and GLS (p=0.0338) (Figure 1).
Conclusions
Six-month HF after STEMI is primarily driven by discharge LV diastolic abnormalities and impaired LA structural–functional integrity rather than global systolic dysfunction, even in patients with preserved or mildly reduced LVEF. Early integrative diastolic–atrial assessment may enhance post-STEMI risk stratification beyond conventional, deformation-based, and myocardial work-derived systolic measures.Figure 1Graphical abstract