Prognostic role of left ventricular global longitudinal strain in patients with primary non-ST-elevation myocardial infarction with heart failure with preserved ejection fraction at discharge

Background

Left ventricular global longitudinal strain(LV GLS) is a sensitive marker of LV dysfunction, showing early impairment before significant changes of ejection fraction(EF). Currently, LV GLS is considered a powerful prognostic tool for identifying early heart damage and predicting heart failure progression.

Purpose

The goal of the study was to detect the prognostic role of LV GLS in patients with primary non-ST-elevation myocardial infarction(pNSTEMI) who had heart failure with preserved ejection fraction(HFpEF) at discharge.

Methods

We investigated 85 patients(45 males, 40 females, mean age 55±8 years) presenting with pNSTEMI and no other concomitant cardiovascular diseases. All patients received management according to current clinical guideline recommendations. At discharge, transthoracic echocardiography was performed using GE Vivid E95 equipment to assess LV GLS. Patients were stratified into two groups based on a GLS cut-off value of –16%:

Group A: Significantly impaired deformation(LV GLS>–16%).

Group B: Preserved or mildly reduced deformation(LV GLS≤–16%).

Results

The study evaluated 1-year rehospitalisation and mortality in 85 patients with preserved ejection fraction(LVEF >50%) and no cardiac chamber dilation. At discharge, patients were divided into two groups: Group A(n=51, 60%) with reduced LV GLS(-9.2% to -15.5%) and Group B(n=34, 40%) with preserved LV GLS(-16.7% to -22.3%). Results indicated that reduced LV GLS was significantly associated with higher rates of adverse outcomes(see table 1). Group A had 13 rehospitalisations (25.49%) and 2 deaths(3.92%), compared to 4 rehospitalisations(11.76%) in Group B (p<0.03).

Conclusion

LV GLS is indeed considered a powerful independent predictor of adverse outcomes, including rehospitalisation and mortality, in patients with HFpEF. Its utility is particularly significant after an acute myocardial infarction, such as a NSTEMI, where it can identify subclinical systolic dysfunction that traditional measures like LVEF might miss.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.