P6502Significance of left ventricular global longitudinal strain assessment in patients with preserved ejection fraction after acute myocardial infarction

Abstract

Background: Depression of left ventricular function is common phenomenon af-ter acute myocardial infarction and it's often associated with poor prognosis. How-ever, substantial portion of patients with acute myocardial infarction had normal left ventricular function by assessment of left ventricular ejection fraction. Purpose(s): In this study, we examined role of left ventricular global longitudinal strain assessment in patients who had normal ejection fraction after acute my-ocardial infarction. Method(s): We choose patients with acute myocardial infarction who were suc-cessfully treated with primary percutaneous coronary intervention (PCI). All of those patients had normal ejection fraction (EF>=55%) in routine echocardio-graphic examination within 3 days after acute myocardial infarction. Two dimen-sional speckle tracking echocardiography was used to assess left ventricular global longitudinal strain. Based on existence of newly onset clinical signs (pul-monary edema, lung crackles, peripherial edema etc.) of heart failure patients divided into case and control group. Patients who had other etiology or previous heart failure were excluded. Result(s): A total of 153 patients with AMI were selected and newly onset heart failure is occurred in 20 patients. Left ventricular global strain was significantly different between patients with clinical heart failure and patients without clinical heart failure (-11.1+/-1.85% vs.-16.6+/-3.38%, p<0.001). After adjustment of possi-ble predictors of impaired left ventricular function such as, age, gender, hyperten-sion, diabetes, previous coronary artery disease, cardiac troponin, mitral inflow EA ratio, deceleration time, left ventricular end diastolic volume, ejection fraction, mitral annulus EE' ratio and wall motion score index, global longitudinal strain was independent predictor of clinical heart failure (odds ratio 1.79, 95% CI 1.22-2.65, p=0.003). Adding global longitudinal strain into above mentioned predictors of clinical heart failure after acute myocardial infarction is associated with signifi-cantly increased C-statistic (0.93, 95% CI 0.87-0.99 vs. 0.97, 95% CI 0.94-0.99, p<0.001). Conclusion(s): Left ventricular global longitudinal strain is independently associated with clinical heart failure in patients with preserved ejection fraction af-ter acute myocardial infarction. Adding global longitudinal strain parameter into screening model may increase rate of precise determination of clinical heart fail-ure after acute myocardial infarction.