Predictive value of global longitudinal strain measured by cardiac magnetic resonance imaging for left ventricular remodeling after acute ST-segment elevation myocardial infarction: a multi-centered prospective study

doi:10.12122/j.issn.1673-4254.2024.06.03

Abstract

Abstract:

Objective To evaluate the predictive value of global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) feature-tracking technique for left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 403 patients undergoing PCI for acute STEMI were prospectively recruited from multiple centers in China. CMR examinations were performed one week (7±2 days) and 6 months after myocardial infarction to obtain GLS, global radial strain (GRS), global circumferential strain (GCS), ejection fraction (LVEF) and infarct size (IS). The primary endpoint was LVR, defined as an increase of left ventricle end-diastolic volume by ≥20% or an increase of left ventricle end-systolic volume by ≥15% from the baseline determined by CMR at 6 months. Logistic regression analysis was performed to evaluate the predictive value of CMR parameters for LVR. Results LVR occurred in 101 of the patients at 6 months after myocardial infarction. Compared with those without LVR (n=302), the patients in LVR group exhibited significantly higher GLS and GCS (P<0.001) and lower GRS and LVEF (P<0.001). Logistic regression analysis indicated that both GLS (OR=1.387, 95% CI: 1.223-1.573; P<0.001) and LVEF (OR=0.951, 95% CI: 0.914-0.990; P=0.015) were independent predictors of LVR. ROC curve analysis showed that at the optimal cutoff value of -10.6%, GLS had a sensitivity of 74.3% and a specificity of 71.9% for predicting LVR. The AUC of GLS was similar to that of LVEF for predicting LVR (P=0.146), but was significantly greater than those of other parameters such as GCS, GRS and IS (P<0.05); the AUC of LVEF did not differ significantly from those of the other parameters (P>0.05). Conclusion In patients receiving PCI for STEMI, GLS measured by CMR is a significant predictor of LVR occurrence with better performance than GRS, GCS, IS and LVEF.

Key words: acute ST-segment elevation myocardial infarction, cardiac magnetic resonance feature tracking, myocardial strain, left ventricular remodeling

Ke LIU, Zhenyan MA, Lei FU, Liping ZHANG, Xin A, Shaobo XIAO, Zhen ZHANG, Hongbo ZHANG, Lei ZHAO, Geng QIAN. Predictive value of global longitudinal strain measured by cardiac magnetic resonance imaging for left ventricular remodeling after acute ST-segment elevation myocardial infarction: a multi-centered prospective study[J]. Journal of Southern Medical University, 2024, 44(6): 1033-1039.

Figures/Tables 7

References 29

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Index	Total population (n=403)	LVR group (n=101)	non-LVR group (n=302)	P
Female [n (%)]	54 (13.4)	11 (10.9)	43 (14.2)	0.393
Age (year)	56.8±10.7	56.7±11.5	56.9±10.4	0.919
BMI (kg/m²)	25.9±7.6	25.6±3.3	26.0±8.6	0.626
SBP (mmHg)	126±22	126±21	126±22	0.832
DBP (mmHg)	77±16	79±16	77±16	0.346
Heart rate (beat/min)	79±14	82±14	79±14	0.039
Current smoker [n (%)]	210 (52.1)	47 (46.5)	163 (54.0)	0.422
Hypertension [n (%)]	201 (49.9)	57 (56.4)	144 (47.7)	0.128
Diabetes [n (%)]	87 (21.6)	23 (22.8)	64 (21.2)	0.738
Hyperlipidemia [n (%)]	81 (20.1)	20 (19.8)	61 (20.2)	0.931
Hb (g/L)	146.5±15.7	146.2±15.6	146.6±15.8	0.821
WBC (10⁹/L)	10.8±3.3	11.5±3.5	10.6±3.2	0.022
PLT (10⁹/L)	229±73	238±69	227±74	0.184
LDL (mmol/L)	3.08±0.93	3.18±1.02	3.06±0.90	0.276
Cr (μmol/L)	77.30±18.58	78.93±17.78	76.76±18.84	0.310
CK-MB peaks (ng/mL)	166 (79.9-297.0)	237.8 (104.5-374.7)	150.9 (73.9-281.1)	0.001
TIMI flow before PCI [n (%)]				0.243
0	296 (73.4)	81 (80.2)	215 (71.2)
1	27 (6.7)	7 (6.9)	20 (6.6)
2	35 (8.7)	6 (6.0)	29 (9.6)
3	45 (11.2)	7 (6.9)	38 (12.6)
Number of affected vessels [n (%)]				0.694
1	186 (46.2)	50 (49.5)	136 (45.1)
2	103 (25.5)	25 (24.8)	78 (25.8)
3	114 (28.3)	26 (25.7)	88 (29.1)
Killp rating [n(%)]				0.052
1	341 (84.6)	79 (78.2)	262 (86.8)
2	50 (12.4)	16 (15.8)	34 (11.3)
3	12 (3.0)	6 (5.9)	6 (2.0)
CMR parameter (%)
GLS	-11.60 (-13.93- -9.34)	-9.24 (-11.15- -7.12)	-12.36 (-14.41- -10.16)	<0.001
GCS	-13.90 (-16.01- -11.7)	-11.90 (-14.11- -9.72)	-14.40 (-16.29- -12.51)	<0.001
GRS	21.39 (17.15-25.59)	17.39 (13.66-22.05)	22.73 (18.63-26.01)	<0.001
IS	22.10 (13.50-32.16)	29.21 (20.21-37.95)	20.08 (11.93-30.37)	<0.001
LVEF	47.84 (40.24-54.13)	39.88 (34.81-47.28)	49.79 (43.11-55.59)	<0.001

Index	Total population (n=403)	LVR group (n=101)	non-LVR group (n=302)	P
Female [n (%)]	54 (13.4)	11 (10.9)	43 (14.2)	0.393
Age (year)	56.8±10.7	56.7±11.5	56.9±10.4	0.919
BMI (kg/m²)	25.9±7.6	25.6±3.3	26.0±8.6	0.626
SBP (mmHg)	126±22	126±21	126±22	0.832
DBP (mmHg)	77±16	79±16	77±16	0.346
Heart rate (beat/min)	79±14	82±14	79±14	0.039
Current smoker [n (%)]	210 (52.1)	47 (46.5)	163 (54.0)	0.422
Hypertension [n (%)]	201 (49.9)	57 (56.4)	144 (47.7)	0.128
Diabetes [n (%)]	87 (21.6)	23 (22.8)	64 (21.2)	0.738
Hyperlipidemia [n (%)]	81 (20.1)	20 (19.8)	61 (20.2)	0.931
Hb (g/L)	146.5±15.7	146.2±15.6	146.6±15.8	0.821
WBC (10⁹/L)	10.8±3.3	11.5±3.5	10.6±3.2	0.022
PLT (10⁹/L)	229±73	238±69	227±74	0.184
LDL (mmol/L)	3.08±0.93	3.18±1.02	3.06±0.90	0.276
Cr (μmol/L)	77.30±18.58	78.93±17.78	76.76±18.84	0.310
CK-MB peaks (ng/mL)	166 (79.9-297.0)	237.8 (104.5-374.7)	150.9 (73.9-281.1)	0.001
TIMI flow before PCI [n (%)]				0.243
0	296 (73.4)	81 (80.2)	215 (71.2)
1	27 (6.7)	7 (6.9)	20 (6.6)
2	35 (8.7)	6 (6.0)	29 (9.6)
3	45 (11.2)	7 (6.9)	38 (12.6)
Number of affected vessels [n (%)]				0.694
1	186 (46.2)	50 (49.5)	136 (45.1)
2	103 (25.5)	25 (24.8)	78 (25.8)
3	114 (28.3)	26 (25.7)	88 (29.1)
Killp rating [n(%)]				0.052
1	341 (84.6)	79 (78.2)	262 (86.8)
2	50 (12.4)	16 (15.8)	34 (11.3)
3	12 (3.0)	6 (5.9)	6 (2.0)
CMR parameter (%)
GLS	-11.60 (-13.93- -9.34)	-9.24 (-11.15- -7.12)	-12.36 (-14.41- -10.16)	<0.001
GCS	-13.90 (-16.01- -11.7)	-11.90 (-14.11- -9.72)	-14.40 (-16.29- -12.51)	<0.001
GRS	21.39 (17.15-25.59)	17.39 (13.66-22.05)	22.73 (18.63-26.01)	<0.001
IS	22.10 (13.50-32.16)	29.21 (20.21-37.95)	20.08 (11.93-30.37)	<0.001
LVEF	47.84 (40.24-54.13)	39.88 (34.81-47.28)	49.79 (43.11-55.59)	<0.001

Parameter	AUC	95%CI	P	Cutoff value
GLS	0.768	0.714-0.823	<0.001	-10.6%
GCS	0.699	0.634-0.760	<0.001	-13.1%
GRS	0.704	0.640-0.763	<0.001	20.1%
IS	0.669	0.606-0.729	<0.001	26.8%
LVEF	0.730	0.668-0.786	<0.001	46.0%

Parameter	AUC	95%CI	P	Cutoff value
GLS	0.768	0.714-0.823	<0.001	-10.6%
GCS	0.699	0.634-0.760	<0.001	-13.1%
GRS	0.704	0.640-0.763	<0.001	20.1%
IS	0.669	0.606-0.729	<0.001	26.8%
LVEF	0.730	0.668-0.786	<0.001	46.0%

Parameter	Z test	AUC difference	95%CI	P
GLS vs LVEF	1.455	0.039	0.013-0.091	0.146
GLS vs GCS	3.063	0.07	0.025-0.114	0.002
GLS vs GRS	2.972	0.064	0.022-0.107	0.003
GLS vs IS	3.091	0.099	0.036-0.162	0.002
LVEF vs GCS	1.292	0.031	0.016-0.078	0.196
LVEF vs GRS	1.077	0.026	0.021-0.072	0.281
LVEF vs IS	1.833	0.06	0.004-0.124	0.067