Prediction of left ventricular remodeling using global and regional longitudinal strain compared with resting myocardial perfusion imaging after primary PCI for patients with anterior STEMI

Background: After an acute myocardial infarction, ischemic injury can cause progressive left ventricular (LV) dilatation and dysfunction (remodeling), which predicts adverse outcomes. Reliable early predictors of final infarct size and remodeling improve risk stratification. Objectives: This study aimed to evaluate the capability and accuracy of global and regional longitudinal strain in the prediction of final LV infarct size and the regional functional recovery of infarcted segments after anterior STEMI compared to resting SPECT. Methods: Prospective cohort of 30 consecutive adults with first anterior STEMI treated by successful primary PCI at our center (May 2022–April 2024). Echocardiography with 2D speckle-tracking (GLS, LSant), standard indices (EF, EDV, ESV, WMSI) were obtained on admission and at 1 month; gated resting SPECT was performed at 1 month. Remodeling was defined as a≥20% increase in LVEDV at 3 months. ROC analysis, correlations, and logistic regression were used to identify predictors. Results: Of 30 patients (mean age 55.5 ± 9.2 years; 63% male), 10 (33%) developed LV remodeling at 3 months. GLS and anterior regional strain correlated negatively with SPECT total perfusion deficit. On univariate analysis, admission predictors of remodeling included GLS ≤ −10.6%, LSant ≤ −6.9%, LVEF ≤ 34%, WMSI > 2.47, and ESV > 63 ml. Limited multivariable modeling identified total ischemic time > 284 minutes as an independent predictor. ROC analyses showed strong discriminative performance for strain and conventional echo indices; SPECT parameters similarly predicted remodeling. Conclusion: Speckle-tracking longitudinal strain correlates with SPECT measures of infarct size and predicts early LV remodeling after anterior STEMI. Findings are exploratory and require confirmation in larger, well-powered studies.