After ST-segment elevation myocardial infarction (STEMI), follow-up imaging is currently recommended only in patients with left ventricular ejection fraction (LVEF) <40%. Left ventricular global longitudinal strain (LVGLS) was shown to improve risk stratification over LVEF in these patients but has not been thoroughly studied during follow-up. The aim of this study was to explore the changes in LVGLS after STEMI and their potential prognostic value. Data were analyzed from an ongoing STEMI registry. Echocardiography was performed during the index hospitalization and 1 year after STEMI; LVGLS was expressed as an absolute value and the relative LVGLS change (ΔGLS) was calculated. The study end point was all-cause mortality. A total of 1,409 STEMI patients (age 60 ± 11 years; 75% men) who survived at least 1 year after STEMI and underwent echocardiography at follow-up were included. At 1-year follow-up, LVEF improved from 50% ± 8% to 53% ± 8% ( < .001) and LVGLS from 14% ± 4% to 16% ± 3% ( < .001). Median ΔGLS was 14% (interquartile range, 0.5%-32%) relative improvement. Starting 1 year after STEMI, a total of 87 patients died after a median follow-up of 69 (interquartile range, 38-103) months. The optimal ΔGLS threshold associated with the end point (derived by spline curve analysis) was a relative decrease >7%. Cumulative 10-year survival was 91% in patients with ΔGLS improvement or a nonsignificant decrease, versus 85% in patients with ΔGLS decrease of >7% ( = .001). On multivariate Cox regression analysis, ΔGLS decrease >7% remained independently associated with the end point (hazard ratio, 2.5 [95% CI, 1.5–4.1]; < .001) after adjustment for clinical and echocardiographic parameters. A significant decrease in LVGLS 1 year after STEMI was independently associated with long-term all-cause mortality and might help further risk stratification and management of these patients during follow-up.

中文翻译：

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ST 段抬高型心肌梗死患者左心室整体纵向应变随访测量的预后价值

ST 段抬高型心肌梗死 (STEMI) 后，目前仅建议对左心室射血分数 (LVEF) <40% 的患者进行随访影像学检查。左心室总体纵向应变（LVGLS）被证明可以改善这些患者的 LVEF 风险分层，但在随访期间尚未得到彻底研究。本研究的目的是探讨 STEMI 后 LVGLS 的变化及其潜在的预后价值。数据分析来自正在进行的 STEMI 登记。首次住院期间和 STEMI 后 1 年进行了超声心动图检查； LVGLS 以绝对值表示，并计算相对 LVGLS 变化（ΔGLS）。研究终点是全因死亡率。共有 1,409 名 STEMI 患者（年龄 60 ± 11 岁；75% 男性）在 STEMI 后存活至少 1 年并在随访时接受超声心动图检查。 1 年随访时，LVEF 从 50% ± 8% 改善至 53% ± 8% ( < .001)，LVGLS 从 14% ± 4% 改善至 16% ± 3% ( < .001)。中位 ΔGLS 相对改善为 14%（四分位数范围，0.5%-32%）。从 STEMI 后 1 年开始，中位随访 69 个月（四分位距，38-103）后，共有 87 名患者死亡。与终点相关的最佳 ΔGLS 阈值（通过样条曲线分析得出）相对下降 >7%。 ΔGLS 改善或无显着下降的患者的累积 10 年生存率为 91%，而 ΔGLS 下降 > 7% (= .001) 的患者的累积 10 年生存率为 85%。在多变量 Cox 回归分析中，调整临床和超声心动图参数后，ΔGLS 下降 >7% 仍与终点独立相关（风险比，2.5 [95% CI，1.5–4.1]；< .001）。 STEMI 后 1 年 LVGLS 显着下降与长期全因死亡率独立相关，可能有助于在随访期间对这些患者进行进一步的风险分层和管理。