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Updated: Mar 5, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Prognostic power of global 2D strain according to left ventricular ejection fraction in patients with ST elevation
Myung-Jin Cha1, Hyun-Sook Kim2, Seong Hwan Kim3
1Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Insights
Global longitudinal strain (GLS) effectively predicts outcomes in ST-elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF). However, GLS does not predict outcomes in patients with preserved LVEF.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Assessing predictive factors for outcomes in acute ST-elevation myocardial infarction (STEMI) is crucial.
- Left ventricular ejection fraction (LVEF) is a key indicator, but its predictive limitations warrant further investigation.
- Strain echocardiography offers novel insights into myocardial mechanics.
Purpose of the Study:
- To evaluate the predictive capability of longitudinal and circumferential strain for clinical outcomes in STEMI patients post-reperfusion.
- To compare the prognostic value of Global Longitudinal Strain (GLS) and Global Circumferential Strain (GCS) in relation to LVEF.
Main Methods:
- A cohort of 691 STEMI patients underwent clinical evaluation and strain echocardiography.
- Global Longitudinal Strain (GLS) and Global Circumferential Strain (GCS) were measured.
- Clinical outcomes included death, heart failure hospitalization, re-infarction, and ventricular arrhythmia.
Main Results:
- Global Longitudinal Strain (GLS) emerged as an independent predictor of adverse outcomes (HR 1.37, p=0.001).
- GLS significantly improved prediction when added to LVEF (χ2 from 31.8 to 45.8, p<0.001).
- GLS predicted outcomes in patients with depressed LVEF (40-50% and <40%), while GCS and LVEF lost predictive power at LVEF <40%.
Conclusions:
- Global Longitudinal Strain (GLS) is a powerful predictor of outcomes in reperfused STEMI patients, particularly those with reduced LVEF.
- Global Circumferential Strain (GCS) and LVEF showed limited predictive value in severely impaired systolic function.
- GLS did not demonstrate predictive power in patients with preserved LVEF (>50%).
Backgrounds:
We aimed to evaluate the predictive power of longitudinal and circumferential fibers according to left ventricular ejection fraction (LVEF) in successfully reperfused acute ST elevation myocardial infarction (STEMI) patients.
Methods:
Total 691 patients (age 59±13, 20% female) underwent clinical evaluation and conventional and strain echocardiography (Global longitudinal strain (GLS), global circumferential strain (GCS)). The clinical outcome was defined as the composite of death, hospitalization for heart failure, non-fatal myocardial infarction, and ventricular arrhythmia.
Results:
During a follow-up of 39±19 months, there were 47 (6.8%) clinical events. In multivariate Cox models adjusted clinical risk factors, age (HR 1.08, p = 0.001) and GLS (HR 1.37, p = 0.001) were independent predictors. The addition of GLS resulted in significant incremental improvement in the predictive value on LVEF (χ2 = 31.8→45.8, p<0.001), although GCS offers no additional benefit. In the subgroup analysis according to LVEF, adjusted with clinical factors, GLS was significant predictive for outcome for the patients with mildly depressed (LVEF 40-50%, HR 2.25, p<0.001) and significantly depressed (LVEF<40%, HR 1.28, p = 0.016) systolic function, although GCS and LVEF lost their power with LVEF<40%. For the patients with preserved LVEF (>50%), GLS, GCS and LVEF did not show significant predictive power.
Conclusions:
GLS is a most powerful predictor of outcome in successfully reperfused STEMI patients, especially with depressed LV dysfunction, although GCS and LVEF lost their predictive power for the patients with significantly depressed LV function. However, GLS did not predict outcome for the patients with preserved LVEF (>50%).
