Journal Article

Comprehensive strain assessment and mortality after acute myocardial infarction: a retrospective observational study based on the Essen Coronary Artery Disease registry

Backmann, Viktoria, Balcer, Bastian, Roggel, Anja, Totzeck, Matthias, Dykun, Iryna, Rassaf, Tienush, Kampf, Jürgen, Mahabadi, Amir A

2024

Overview

Background and aimsCurrent ESC guidelines on the management of patients after acute myocardial infarction only include the evaluation of left ventricular (LV) function by assessment of the ejection fraction in addition to clinical risk scores to estimate the patient’s prognosis. We aimed to determine, whether comprehensive evaluation of cardiac function using LV and right ventricular (RV) global longitudinal strain (GLS) and left atrial (LA) reservoir strain improves the prediction of survival in patients with acute myocardial infarction.MethodsIn patients with non-ST segment elevation or ST segment elevation myocardial infarction receiving echocardiography within 1 year after revascularisation, LV-GLS, RV-GLS and LA reservoir strain were quantified. In multivariable Cox regression analysis, HRs and 95% CIs were calculated per 1 SD increase in strain measure, adjusting for age, sex, systolic blood pressure, low-density lipoprotein cholesterol, smoking, diabetes and family history of premature coronary artery disease.ResultsDuring a median follow-up of 1.5 (0.5–4.2) years, 157 (11.1%) out of 1409 patients (64.4±13.5 years, 24.7% female) died. LV-GLS (1.68 (1.37–2.06), p<0.001), RV-GLS (1.39 (1.16–1.67), p<0.001) and LA reservoir strain (0.57 (0.47–0.69), p<0.001) were associated with mortality. Adding LV ejection fraction, tricuspid annular plane systolic excursion (TAPSE) or LA volume index to these models did not alter the association of strain measures of the LV (1.41 (1.06–1.89), p=0.02), RV (1.48 (1.03–2.13), p=0.04) or LA (0.61 (0.49–0.76), p<0.001). In receiver operating characteristics, combining the three strain measures improved the prediction of mortality above risk factors (AUC: 0.67 (0.63–0.71) to 0.75 (0.70–0.80)), while further addition of LV ejection fraction, TAPSE and LA volume index did not (0.75 (0.70–0.81)).ConclusionThe comprehensive evaluation of contractility of various cardiac chambers via transthoracic echocardiography using myocardial strain analysis, when routinely performed after acute myocardial infarction, may help to detect patients at increased mortality risk.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: acute myocardial infarction / Aged / Angina pectoris / Atrial Function, Left - physiology / Blood pressure / Body mass index / Cardiovascular disease / Cholesterol / Coronary Artery Disease / Coronary vessels / Diabetes / echocardiography / Echocardiography - methods / Ejection fraction / Family medical history / Female / Heart attacks / Humans / Male / Medical prognosis / Middle Aged / Mortality / Myocardial Infarction - diagnosis / Myocardial Infarction - mortality / Myocardial Infarction - physiopathology / Non-ST Elevated Myocardial Infarction - diagnosis / Non-ST Elevated Myocardial Infarction - mortality / Non-ST Elevated Myocardial Infarction - physiopathology / Observational studies / Original Research / Patients / Predictive Value of Tests / Prognosis / Registries / Regression analysis / Retrospective Studies / Risk Assessment - methods / Risk Factors / Sensitivity analysis / Software / ST Elevation Myocardial Infarction - diagnosis / ST Elevation Myocardial Infarction - mortality / ST Elevation Myocardial Infarction - physiopathology / Stroke Volume - physiology / Variables / Vein & artery diseases / Ventricular Function, Left - physiology / Ventricular Function, Right - physiology