Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction

OBJECTIVES: This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%. BACKGROUND: LVEF is a key determinant in decision making after acute MI, yet it is relatively indiscriminant within the normal range. Novel echocardiographic deformation parameters may be of particular clinical relevance in patients with relatively preserved LVEFs. METHODS: Patients with MIs and LVEFs >40% within 48 h of admission for coronary angiography were prospectively included. All patients underwent echocardiography with semiautomated measurement of GLS. The primary composite endpoint (all-cause mortality and hospitalization for heart failure) was analyzed using Cox regression analyses. The secondary endpoints were cardiac death and heart failure hospitalization. RESULTS: A total of 849 patients (mean age 61.9 ± 12.0 years, 73% men) were included, and 57 (6.7%) reached the primary endpoint (median follow-up 30 months). Significant prognostic value was found for GLS (hazard ratio HR: 1.20; 95% confidence interval CI: 1.10 to 1.32; p  -14% was associated with a 3-fold increase in risk for the combined endpoint (HR: 3.21; 95% CI: 1.82 to 5.67; p  -14% was significantly associated with cardiovascular death (HR: 12.7; 95% CI: 3.0 to 54.6; p 40% above and beyond traditional indexes of high-risk MI.