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Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial
Sebastian J Reinstadler1, Gert Klug1, Hans-Josef Feistritzer1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria.
Insights
The left ventricular global function index (LVGFI) predicts major adverse cardiac events after ST-segment elevation myocardial infarction (STEMI). While a strong predictor, LVGFI did not offer additional prognostic value beyond left ventricular ejection fraction (LVEF).
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- Left ventricular global function index (LVGFI) is a novel measure of cardiac performance.
- The prognostic significance of LVGFI after ST-segment elevation myocardial infarction (STEMI) remains unestablished.
- Cardiovascular magnetic resonance (CMR) imaging is a key tool for cardiac assessment.
Purpose of the Study:
- To evaluate the prognostic value of LVGFI measured by CMR in patients post-STEMI.
- To determine if LVGFI can predict major adverse cardiac events (MACE).
Main Methods:
- Two hundred STEMI patients underwent CMR imaging within days of primary percutaneous coronary intervention.
- LVGFI was calculated from cine and late enhancement CMR images.
- Patients were followed for major adverse cardiac events (MACE), defined as death, re-infarction, or heart failure.
Main Results:
- Patients experiencing MACE had significantly lower LVGFI.
- Decreased LVGFI was associated with reduced MACE-free survival (P < 0.001).
- LVGFI independently predicted MACE (HR=4.79, P=0.010) but did not provide incremental value over LVEF (P=0.38).
Conclusions:
- LVGFI assessed by CMR is a significant predictor of MACE within three years post-STEMI.
- LVGFI demonstrates strong predictive capability for adverse cardiac events in STEMI patients.
- The study did not find LVGFI to be superior to LVEF in prognostic assessment.
Aims:
The left ventricular global function index (LVGFI) is a novel indicator of left ventricular performance. Its prognostic value in patients after ST-segment elevation myocardial infarction (STEMI) is unknown. We sought to evaluate the prognostic significance of LVGFI measured by cardiovascular magnetic resonance (CMR) imaging after STEMI.
Methods And Results:
Two hundred eligible STEMI patients (56 ± 11 years, 16% female) revascularized by primary percutaneous coronary intervention were followed-up for 3.1 [2-4.1] years for major adverse cardiac events (MACE). MACE was defined as a composite of death, non-fatal myocardial re-infarction, and new congestive heart failure. All patients underwent CMR imaging within 2 [2-4] days after STEMI. Late enhancement and cine images were acquired to assess myocardial injury as well as myocardial function, including LVGFI. Patients suffering a MACE event (n = 20, 10%) had a significantly lower LVGFI (P = 0.001). In Kaplan-Meier analysis, a decreased LVGFI was associated with a reduced MACE-free survival (P < 0.001). Multivariate Cox regression analysis revealed a decreased LVGFI as a predictor for MACE [hazard ratio = 4.79, 95% confidence interval (CI) 1.46-15.67, P = 0.010] after adjusting for microvascular obstruction, left ventricular mass, and multivessel disease. In receiver operating characteristic analysis, LVGFI was a strong predictor for MACE (area under the curve = 0.73, CI 0.61-0.85). However, c-statistics revealed that LVGFI does not provide incremental prognostic information over left ventricular ejection fraction (LVEF) (P = 0.38).
Conclusion:
LVGFI assessed by CMR is a strong predictor of MACE within 3 years after first STEMI. A superior predictive value as compared with LVEF was not found in this study.
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