Key result
Baseline CMR-FT global longitudinal strain linked to ~2.1-fold higher MACE risk after acute STEMI.
Why the study?
To assess the recovery and prognostic values of CMR-FT myocardial strain in acute anterior and non-anterior wall myocardial infarction.
Does myocardial strain measured by CMR feature-tracking (GRS, GCS, GLS) recover differently by infarct location and independently predict medium-term MACE in patients with reperfused first-time acute STEMI?
Cohort (n=103)
CMR images were analyzed by two cardiac radiologists blinded to patient history and clinical outcome
No
Does myocardial strain measured by CMR feature-tracking (GRS, GCS, GLS) recover differently by infarct location and independently predict medium-term MACE in patients with reperfused first-time acute STEMI?
CMR feature-tracking global longitudinal strain improves over 4 months after primary PCI for STEMI—particularly in non-anterior infarcts—and provides contrast-free independent prognostic value for medium-term MACE alongside infarct size and microvascular obstruction.
Answers are grounded in this paper and cite their sources.
GLS may aid post-STEMI risk stratification alongside infarct size; leaves open incremental value over standard CMR metrics in prospective studies.
BACKGROUND: To assess the recovery and prognostic values of myocardial strain using cardiac magnetic resonance (CMR)- feature tracking (FT) in acute anterior and non-anterior wall myocardial infarction. METHODS: 103 reperfused patients after STEMI who underwent CMR at about 4 days (baseline) and 4 months (follow-up) were included, including 48 and 55 patients with anterior wall myocardial infarction (AWMI) and non-anterior wall myocardial infarction(NAWMI). CMR-FT analysis was performed using cine images to measure LV global radial, circumferential, and longitudinal peak strains (GRS, GCS, and GLS, respectively). Infarct size (IS) and microvascular obstruction (MVO) were estimated by late-gadolinium enhancement imaging. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) after infarction. RESULTS: Patients with AWMI had higher IS, higher MVO, lower ejection fraction, and more significantly impaired CMR-FT strain values than patients with NAWMI (all p<0.05). Global strain significantly improved at 4 months (all p<0.01), especial in NAWMI. GLS was an independent predictor (odds ratio = 2.08, 95% confidence interval = 1.032-4.227, p = 0.04] even after adjustment for IS and MVO. The optimal cutoff of GLS was -7.9%, with sensitivity and specificity were 73.3% and 75.0%, respectively. In receiver operating characteristic analysis, IS remained the strongest predictor (area under the curve [AUC] = 0.83, p<0.01), followed by MVO (AUC = 0.81, p<0.01) and GLS (AUC = 0.78, p<0.01). CONCLUSION: CMR-FT-derived global myocardial strains significantly improved over time, especial in NAWMI. GLS measurement independently predicted the occurrence of medium-term MACE.
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Wang et al. (2023) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (n=103). CMR feature-tracking global longitudinal strain (GLS) and anterior vs. non-anterior wall MI location vs. Non-anterior wall myocardial infarction (NAWMI, n=48) vs. anterior wall myocardial infarction (AWMI, n=55) was evaluated on Major adverse cardiac events (MACE), defined as recurrent angina pectoris, acute myocardial infarction, heart failure, and death due to coronary heart disease (OR 2.09, 95% CI 1.03-4.23, p=0.042). Baseline CMR-FT global longitudinal strain independently predicted medium-term MACE after acute STEMI (OR 2.09, 95% CI 1.03-4.23, p=0.042), alongside infarct size and microvascular obstruction.
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