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Global longitudinal strain by feature tracking for optimized prediction of adverse remodeling after ST-elevation myocardial infarction

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Abstract

Background

The role of left ventricular (LV) myocardial strain by cardiac magnetic resonance feature tracking (CMR-FT) for the prediction of adverse remodeling following ST-elevation myocardial infarction (STEMI), as well as its prognostic validity compared to LV ejection fraction (LVEF) and CMR infarct severity parameters, is unclear. This study aimed to evaluate the independent and incremental value of LV strain by CMR-FT for the prediction of adverse LV remodeling post-STEMI.

Methods

STEMI patients treated with primary percutaneous coronary intervention were enrolled in this prospective observational study. CMR core laboratory analysis was performed to assess LVEF, infarct pathology and LV myocardial strain. The primary endpoint was adverse remodeling, defined as ≥ 20% increase in LV end-diastolic volume from baseline to 4 months.

Results

From the 232 patients included, 38 (16.4%) reached the primary endpoint. Global longitudinal strain (GLS), global radial strain, and global circumferential strain were all predictive of adverse remodeling (p < 0.01 for all), but only GLS was an independent predictor of adverse remodeling (odds ratio: 1.36[1.03–1.78]; p = 0.028) after adjustment for strain parameters, LVEF and CMR markers of infarct severity. A GLS > − 14% was associated with a fourfold increase in the risk for LV remodeling (odds ratio: 4.16[1.56–11.13]; p = 0.005). Addition of GLS to a baseline model comprising LVEF, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.26 ([0.13–0.38]; p < 0.001) and integrated discrimination improvement of 0.02 ([0.01–0.03]; p = 0.006).

Conclusions

In STEMI survivors, determination of GLS using CMR-FT provides important prognostic information for the development of adverse remodeling that is incremental to LVEF and CMR markers of infarct severity.

Clinical Trial Registration

NCT04113356.

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Funding

This study was supported by research grants from the 'Austrian Society of Cardiology' and by an intramural funding program of the Medical University Innsbruck MUI-START, Project 2015-06-013.

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Authors and Affiliations

  1. University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Martin Reindl, Christina Tiller, Magdalena Holzknecht, Ivan Lechner, Dorothea Eisner, Laura Riepl, Gert Klug, Axel Bauer, Bernhard Metzler & Sebastian J. Reinstadler

  2. University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Mathias Pamminger, Benjamin Henninger & Agnes Mayr

  3. Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Innsbruck, Austria

    Johannes P. Schwaiger

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  1. Martin Reindl
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Correspondence to Sebastian J. Reinstadler.

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The study conducted in compliance with the Declaration of Helsinki and received approval by the research ethics committee of the Medical University of Innsbruck.

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Reindl, M., Tiller, C., Holzknecht, M. et al. Global longitudinal strain by feature tracking for optimized prediction of adverse remodeling after ST-elevation myocardial infarction. Clin Res Cardiol 110, 61–71 (2021). https://doi.org/10.1007/s00392-020-01649-2

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