Left ventricular strain: A reliable predictor of short-term outcomes in patients with anterior wall myocardial infarction without heart failure

Abstract

Background: Left ventricular ejection fraction (LVEF) is a key determinant in decision-making after acute myocardial infarction (MI). Little is known of its relationship with left ventricular Strain and N-Terminal fragment of pro-B-type Natriuretic Peptide (NT-pro-BNP) following acute anterior wall MI (AWMI). Materials and Methods: We conducted a prospective cohort study of patients with a diagnosis of acute AWMI and the absence of overt heart failure (HF). Assessment of LVEF, strain parameters on echocardiography was done, and NT-pro-BNP levels were obtained. Follow-up for adverse cardiac events was done for 30 days postdischarge. Correlation of LVEF and NT-pro-BNP with various strain parameters were ascertained. Results: Of the total of 50 patients of AWMI enrolled, the mean LVEF in the study was 43.46 ± 3.72%.Eleven patients (22%) had adverse events at 30 days of follow-up. Patients with adverse events had significantly higher overall peak systolic longitudinal strain (PSLS), lower mid-region peak systolic longitudinal velocity (PSLV), and basal region PSLV. A significant negative correlation was observed between LVEF and mean Peak PSLS of combined apical plus mid regions of the left ventricle (r = −0.700). Log10-NT-pro BNP also showed a strong negative correlation with overall PSLV (r = −0.792) as well as regional PSLV values of combined apical plus mid (r = −0.763) and basal segments (r = −0.748). Conclusions: In patients with AWMI without HF, PSLS and PSLV are good predictors of adverse outcomes at 30-day follow-up. Furthermore, NT-pro BNP can also be an indirect predictor of strain parameters on echocardiography.

Keywords

• echocardiography
• heart failure
• left ventricular strain
• natriuretic peptides
• peak systolic longitudinal velocity