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Global longitudinal strain as a predictor of cardiovascular events and mortality after myocardial infarction
Session:
Painel 8 - Doença Coronária 12
Speaker:
João Miguel Santos
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Miguel Santos; Inês Pires; Luísa Gonçalves; Joana Laranjeira Correia; Hugo Da Silva Antunes; Inês Almeida; Bruno Marmelo; Emanuel Correia; José Costa Cabral
Abstract
<p><strong>Introduction</strong></p> <p>Global longitudinal strain (GLS) is an earlier marker of systolic dysfunction than other methods used in routine clinical practice, such as ejection fraction (EF). This study aimed to compare the impact of different measures of left ventricle systolic function on prognosis of patients presenting with acute myocardial infarction (AMI).</p> <p><strong>Methods </strong></p> <p>Retrospective analysis of 170 patients admitted due to AMI. We included EF measurement using Simpson biplane, lateral mitral annulus plane systolic excursion (MAPSE), GLS measured by “speckle tracking”, systolic index of contractility (dp/dt) and cardiac output (CO) assessed by pulsed-wave doppler in the analysis. All measurements were made by the same operator. Mann-Whitney U was used for univariate analysis and logistic regression for multivariable analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 6-month (6MM) and 12-month mortality (12MM), and in the combined endpoint of cardiovascular event or death at 12 months (12CVM). ROC curve analysis was performed to evaluate mortality descrimination with systolic function measures.</p> <p><strong>Results</strong></p> <p>Mean patient age was 64 (±14) years; 74% were men. 49% had ST elevation AMI. Mean EF was 49% (±10), GLS -14 (±5.1), dp/dt 1009 mmHg/s (±345), MAPSE 11.1 (±2.6), CO 4.3 l/min (±1.4). 6MM and 12MM were 4.6% and 15%, respectively. A statistically significant association between 6MM was found in univariate analysis for GLS only (p=0.04). A significant association with 12MM in univariate analysis was noted for EF, MAPSE and GLS (p<0.001). There was an association in univariate analysis between EF (p=0.019), MAPSE (0.006), GLS (<0.001) and 12CVM. In multivariable analysis, GLS was the only variable independently associated with 12MM (Exp(B): 0.663, p=0.009) and 12CVM (Exp(B): 0.779, p=0.025). Kaplan-Meyer survival plots revealed that a compromised GLS (<-16) was associated with significantly increased 12MM (24.7% vs 2.4%, X<sup>2 </sup>:9.085, p=0.003) and 12CVM (27.6% vs 9.6%, X<sup>2 </sup>:5.003, p=0.025). When stratified by EF>40%, GLS was still a statistically significant predictor of 12MM (22.7% vs 2.4%<strong>, </strong>X<sup>2 </sup>:7.999, p=0.005) in this subgroup. Cox-regression analysis including GLS and other variables such as age, number of affected coronary vessels and EF, demonstrated a statistically significant association between 12MM and GLS (HR: 0.62, p=0.007), as for 12CVM (HR: 0.69, p=0.003). After AMI, for each positive unit increase in GLS, hazard of 12CVM and 12MM decreases by 69% and 62%, respectively. ROC curve analysis revealed excellent discrimination power for 12MM prediction of GLS (AUC: 0.85, p<0.001).</p> <p><strong>Conclusion</strong></p> <p>GLS is an independent predictor of 12MM and 12CVM in patients presenting with AMI. Its discriminating ability outperforms other measures of systolic function, including EF. Routine measurement of GLS should be considered in these patients.</p> <p> </p> <p> </p>
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