P965Longitudinal global peak systolic strain - a reliable predictor of survival in patients with ST-elevation acute myocardial infarction


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Abstract

Background: ST-elevation myocardial infarction (STEMI) still has a significant morbidity and mortality. Consequently it is crucial to identify biological parameters that may help in the risk stratification of these patients. Longitudinal global peak systolic strain obtained by speckle-tracking has been associated with the amount of myocardial necrosis; therefore it may have an important predictive value in this setting.Aim: to evaluate the predictive value of longitudinal global peak systolic strain in STEMI.Methods: Eighty nine consecutive (63±13 years; 74% males) patients (pts) with first-ever ST-elevation myocardial infarction (STEMI) treated by primary angioplasty were studied. All pts underwent standard echo Doppler and 2DSE within 72 hours after admission. In post-processing, longitudinal global peak systolic strain was measured. In the follow-up of these patients, cases of death or re-infartion were registered. The prognostic accuracy was assessed for the composite endpoint of death or re-infartion with the Kaplan-Meier curve. The threshold value was determined by the Receiver Operator Curve (ROC).Results: The image quality was adequate to evaluate the longitudinal global peak systolic strain in 81 pts (91%). The mean ejection fraction was 54±11% and the mean longitudinal global peak systolic strain -13,7±4,2%. In the follow-up period (19±6 months) 4 pts died (5%), 6 pts had re-infarction (9%) and the endpoint death and re-infarction occurred in 9 cases (13%). The pts who showed worse outcome had a significantly lower longitudinal global peak systolic strain in the initial evaluation (-10,9±2,9% vs -14,2±4,2%; p=0,018). The accuracy of longitudinal global peak systolic strain as a predictor parameter was moderate (ROC: 0,75; IC95% 0,62-0,88; p=0,018) with a sensitivity of 67% and a specificity of 69%. Pts with longitudinal global peak systolic strain less negative than -15% had a significant higher risk of death or re-infarction (21,4% vs 0%; Odds ratio: 1,27 IC95% 1,09-1,49; p=0,009).Conclusion: STEMI patients with impaired longitudinal global peak systolic strain (< -15%) had a higher risk of death or re-infarction at follow up. The analysis of myocardial deformation with speckle-tracking demonstrated prognostic value in the assessment of pts with STEMI,Figura. Survival curve of pts with STEMI and longitudinal global peak systolic strain

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