Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function

Fig. 1. Representative cases. The bull’s eye map of post-systolic index (PSI) and longitudinal strain curves of six myocardial segments in the apical four-chamber view of the patients without (A, B) and with (C, D) major adverse cardiovascular events during follow-up. Both patients showed normal global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF). A Normal bull’s eye map of PSI with an average value of 3.3%. B Normal strain curves with little or no sign of post-systolic shortening (PSS). C Abnormal bull’s eye map of PSI with an increased average value of 16.0%. D Abnormal strain curves where the green segment exhibits obvious PSS

Fig. 2. Event-free survival. Kaplan–Meier survival curves for adverse events prediction by (A) LVEF; (B) E/A; (C) E/e′; (D) GLS; (E) PSI; (F) the number of left ventricle walls with PSS. LVEF: left ventricular ejection fraction; E/A: mitral inflow peak early velocity/mitral inflow peak late velocity; E/e′: mitral inflow peak early velocity/mitral annular peak early velocity; GLS: global longitudinal strain; PSI: post-systolic index; PSS: post-systolic shortening

Fig. 3. Restricted cubic splines of nonlinear association between LnPSI and hazard ratio. The bold red lines indicate the pooled restricted cubic spline model, and the red filled area indicates the 95% confidence intervals of the pooled curve. PSI: post-systolic index

Fig. 4. Event-free survival. Kaplan–Meier survival curves for adverse events prediction in patients with stratification of GLS > 15.4% by (A) GLS; (B) the number of left ventricle walls with PSS. GLS: global longitudinal strain; PSI: post-systolic index; PSS: post-systolic shortening