The e predictive valu lue of of glo global lon longitudinal str - - PDF document

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The e predictive valu lue of

• f glo

global lon longitudinal str train on

• n

clin clinical ou

• utcome in

in pati tients wit ith ST-segment ele elevation myocardial in infarction and preserv rved systolic fu function

Ben endary A A * * MD, T , Tawfi fik W MD, , Mah ahros M M MD , , Sale Salem M MD,PhD

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• Not all patients with preserved LVEF after STEMI are equal when it

it comes to to short an and long long term erm out

• utcome.
• Measurement of
• f LVEF fol
• llowing STEMI has long been a cornerstone step for risk

stratification process that helps to to guide treatment decisions and other secondary preventive mea easures.

• Patients with preserved LVEF following STEMI are always left with weak and

amb ambiguous treatment rec ecommendatio ions in in the he gui guidelines.

• HO

HOWEVER, LVE VEF lac lacks ris isk disc discriminative po power wit ithin no normal ran anges.

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• The main focus in

in recent few years has been on

• n global longitudinal strain (GLS)

which reflects the function of

• f sub-endocardial longitudinal myofibers that are

very sen sensi sitive to to isch ischemic ic da damage.

• We

We think that it’s essential to to look for novel measures for LV LV systolic function (other than LVEF) which could define high risk patients among a group that has alw always be been mis istakenly tho hought to to be be at at lo low risk isk.

• Th

Thus, we we thought that it it may be be of

• f considerable interest to

to explore the predictive value of

• f early GLS on
• n 30

30-day outcome among apparently low-risk patients with suc success ssful rep eperfusio ion and and pr preserved LVE VEF follo

• llowing STEMI.

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LVEF < 50% VEF < 50%

165 165 with suc uccess essful re reper erfusi sion

• n scr

cree eened ed 149 149 rem remaining 16 16 ex excluded

• AF (n=

n=8) 8)

• Pace

e rhyt ythm (n= n=3) 3)

• Mor
• re tha

han mild AS (n= n=5) 5) 140 140 rem remaining 9 ex excl cluded ed due due to po poor

• r

image e qua quality 110 110 pa patien ents s lef eft for r fina nal ana nalysi sis 30 30 ex excluded due due to LVEF < 50%

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DM= Diabetes Mellitus, HTN= Hypertension, FH= Family history, CAD= Coronary artery disease, PH= Past history, STEMI= St- elevation myocardial infarction, PCI= Percutaneous coronary interventions, CABG= Coronary artery bypass graft

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ESV= End-systolic volume, EDV= End-diastolic volume, EF= Ejection fraction, GLS= Global longitudinal strain, WMSI= Wall motion score index

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Sen Sensiti tivity 77. 77.8% Spe Specific icity ty 83. 83.7%

Cut ut-off

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• Cas

ase # 17 17

• Male

ale, 55 55 years old

• ld
• An

Anterior STEMI rec eceived PPCI

• Bas

aseli line LVE VEF by by Sim Simpson is is 56 56%

• Bas

aseli line GLS LS – 13 13.8%

• No

No rep eported MACEs at at 30 30-days Fu Fup

• A. Apical-4 chamber (AP4) longitudinal strain B.

Apical-2 chamber (AP2) longitudinal strain C. Apical-3 chamber longitudinal strain D. Bull’s eye polar map of GLS.

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• Semiautomated

calculation

• f
• f

GLS si significantly predicts 30 30-day adverse

• utcome in

in patients with preserved LVEF fol

• llo

lowing STEMI above and beyond traditional ide identif ifiers of

• f hig

high risk isk.

• We

We recommend close monitoring to to those patients by by scheduling frequent fol

• llow-up

up visi sits and attention to to proper prescription

• f
• f

guideline directed medical and in interventio ional the herapie ies.