Global longitudinal strain in long-term risk prediction after acute coronary syndrome: an investigation of added...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Prognostic Biomarkers

Background:

• Acute coronary syndrome (ACS) survivors face long-term risks of death and heart failure (HF) re-hospitalization.
• Left ventricular ejection fraction (LVEF) is a standard prognostic marker, but its predictive capacity may be limited.
• Global longitudinal strain (GLS) measures myocardial deformation and may offer incremental prognostic information.

Purpose of the Study:

• To evaluate the added prognostic value of GLS over LVEF for predicting long-term combined death and HF re-hospitalization in ACS patients.
• To assess GLS and LVEF as independent predictors of adverse outcomes post-ACS.

Main Methods:

• Retrospective analysis of 941 patients admitted with ACS (2008-2014).
• LVEF and GLS assessed during index hospitalization; outcomes followed for a median of 6.2 years.
• Cox proportional hazards models and C-statistics used for prognostic and nested model comparisons.

Main Results:

• Both GLS and LVEF were independent predictors of the combined outcome (death or HF re-hospitalization).
• The C-statistic for risk prediction was 0.742 with clinical data and LVEF, increasing slightly to 0.749 upon addition of GLS (P=0.693).
• GLS did not provide statistically significant incremental predictive value when LVEF was already incorporated into the model.

Conclusions:

• Global longitudinal strain is an independent predictor of long-term mortality and heart failure re-hospitalization after ACS.
• However, GLS does not offer significant additional predictive power for these combined outcomes when left ventricular ejection fraction is known.