Changes and influence on prognosis of left ventricular global longitudinal strain in patients with ST-segment elevation myocardial infarction and impaired left heart function after PCI
Ma Xiangming
Wang Fang
Chen Zaishu
Li Xueyuan
Abstract：Objective To explore the changes in left ventricular global longitudinal strain(LVGLS)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)and impaired left ventricular function,and its impact on prognosis.Methods STEMI patients(n=258)with impaired left ventricular function who underwent PCI in Wuhan University Zhongnan Hospital Jiayu Hospital from January 2020 to March 2023 were selected as the study subjects.According to the occurrence of major adverse cardiovascular events(MACE)during postoperative follow-up(7～16 months),patients were divided into the MACE group(n=58)and the non-MACE group(n=200).Multivariable linear regression(MLR)model was used to analyze the correlation between LVGLS and coronary flow reserve(CFR),index of microcirculatory resistance(IMR).Cox regression model was used to analyze the relationship between LVGLS grouping and MACE risk.Restricted cubic splines(RCS)and threshold effects were used to analyze dose-response relationships.Results Compared with the non MACE group,the MACE group had higher proportion of patients with Killip grade＞Ⅱ,culprit vessel in the left anterior descending artery(LAD),and no reflow during surgery,as well as higher white blood cell count(WBC)levels,N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels,and pre-and post-operative IMR(P＜0.05).In contrast,left ventricular ejection fraction(LVEF),pre-and postoperative LVGLS,and CFR were lower(P＜0.05).MLR analysis results showed positive correlation between LVGLS and CFR before and after surgery(P＜0.05),and negative correlation with IMR(P＜0.05),and after adjusting for confounding factors,there was still significant correlation(P＜0.05).After adjusting for confounding factors(Model 2),Cox regression analysis showed that with LVGLS Q1 group as reference,the HR(95%CI)of Q2 group,Q3 group,and Q4 group were 0.902(0.891～0.917),0.601(0.501～0.713),and 0.434(0.322～0.569),respectively,and the difference in trend test was also statistically significant(P＜0.001).RCS model analysis results showed non-linear relationship between continuous changes in LVGLS and MACE risk(nonlinear test P＜0.001).The threshold effect analysis results showed that the inflection point of LVGLS on MACE was-16.2%.When LVGLS was less than-16.2%,the risk of MACE significantly decreased as LVGLS increased;however,when LVGLS was≥-16.2%,the risk of MACE no longer decreased with further increases in LVGLS.Conclusion For STEMI patients with impaired left ventricular function,the improvement of LVGLS after PCI is significantly associated with reduction in MACE risk.
Keywords：Acute myocardial infarctionPercutaneous coronary interventionLeft ventricular global longitudinal strainPrognosis
Publication Date：2025-06-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 740-745 )