Prognostic value of myocardial longitudinal strain for left ventricular remodeling in patients with successfully Reperfused Anterior STEMI

Background: LV remodeling and subsequent heart failure (HF) following acute myocardial infarction (AMI) are linked to unfavorable prognosis. The present study was designed to evaluate the predictive value of global longitudinal strain (GLS), assessed using two-dimensional speckle tracking echocardiography (2D STE), for the occurrence of LV remodeling in cases with acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI). Methods: This investigation included 57 cases diagnosed with ant-STEMI who underwent successful primary coronary intervention and had two-dimensional speckle tracking echocardiography (2D STE) data, in addition to standard transthoracic two-dimensional echocardiographic assessment. All participants were prospectively followed for a period of six months, after which transthoracic echocardiographic evaluation was repeated. Results: At the 6-month follow-up, left ventricular (LV) volumes and ejection fraction (EF) were reassessed. LV remodeling was defined as an increase in LV end-diastolic volume (EDV) of ≥ 20% compared with baseline measurements. Remodeling occurred in 12 cases (21.05%), while the remaining 45 cases (78.9%) exhibited no evidence of remodeling. Multivariate analysis of baseline echocardiographic parameters revealed no substantial variations between the two groups in LV end-diastolic diameter (LVEDD), LV end-systolic volume (LV ESV), or LV EDV. In contrast, the LV remodeling group demonstrated a statistically significant increase in LV end-systolic diameter (LV ESD) and a significantly lower EF. Moreover, this group exhibited markedly higher LV peak systolic GLS values, with the optimal cut-off identified as > -12.8 (sensitivity 91.6%, specificity 93.4%). Wall motion score index (WMSI) was also substantially elevated in remodeling group, with the best cut-off determined as > 1.59 (sensitivity 92.5%, specificity 88.3%). Independent predictors of LV remodeling were WMSI, GLS and total ischemic time. Conclusion: GLS represents a robust echocardiographic indicator associated with the occurrence of LV remodeling at 6 months in cases with ant-STEMI who have undergone successful reperfusion.