Myocardial Longitudinal Strain in Prediction of LV Remodeling in Patients with Successfully Reperfused Anterior Wall ST-Segment Elevation Myocardial Infarction

Background: LV remodeling and subsequent heart failure (HF) following acute myocardial infarction (AMI) are linked to unfavorable prognosis.
Objective: The present study was designed to evaluate the predictive value of global longitudinal strain (GLS), assessed using two-dimensional speckle tracking echocardiography (2D STE), for the occurrence of LV remodeling in cases with acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI).
Subjects and methods: This investigation included 57 cases diagnosed with ant-STEMI who underwent successful primary coronary intervention and had two-dimensional speckle tracking echocardiography (2D STE) data, in addition to standard transthoracic two-dimensional echocardiographic assessment. All participants were prospectively followed for a period of six months, after which transthoracic echocardiographic evaluation was repeated.
Results: At the 6-month follow-up, left ventricular (LV) volumes and ejection fraction (EF) were reassessed. LV remodeling was defined as an increase in LV end-diastolic volume (EDV) of ≥ 20% compared to baseline measurements. Remodeling occurred in 12 cases (21.05%), while the remaining 45 cases (78.9%) exhibited no evidence of remodeling. Multivariate analysis of baseline echocardiographic parameters revealed no substantial variations between the two groups in LV end-diastolic diameter (LVEDD), LV end-systolic volume (LV ESV), or LV EDV. In contrast, the LV remodeling group demonstrated a statistically significant increase in LV end-systolic diameter (LV ESD) and a significantly lower EF. Moreover, this group exhibited markedly higher LV peak systolic GLS values, with the optimal cut-off identified as > –12.8 (sensitivity 91.6% & specificity 93.4%). Wall motion score index (WMSI) was also substantially elevated in remodeling group, with the best cut-off determined as > 1.59 (sensitivity 92.5% & specificity 88.3%). Independent predictors of LV remodeling were WMSI > 1.59, GLS > –12.5%, and total ischemic time.
Conclusion: GLS represents a robust echocardiographic indicator associated with the occurrence of LV remodeling at 6 months in cases with ant-STEMI who underwent successful reperfusion.