Long-term prognostic impact of one-year change in left ventricular function after a myocardial infarction: insights from the REBUS cohort

TL;DR

This study found that changes in heart function after a heart attack do not improve long-term risk prediction, but worsening strain may signal worse outcomes.

Contribution

The study shows that baseline global longitudinal strain (GLS) is more predictive than changes in ejection fraction or GLS over one year.

Findings

Improvement in LVEF and GLS after one year was not linked to better long-term outcomes.

Deterioration in GLS was associated with a higher risk of heart failure or death.

Baseline GLS had better predictive accuracy than baseline LVEF.

Abstract

Acute myocardial infarction (MI) management has changed in the last decades with the introduction of routine early invasive revascularization and potent antiplatelet therapy followed by an improvement in patient prognosis. This study aimed to evaluate if it remains of long-term prognostic value to repeat the assessment of systolic function, determining change in ejection fraction (LVEF) and global longitudinal strain (GLS), within a year after an MI.

Patients hospitalized with acute MI (n = 256) were recruited in 2010 through 2012 at Uppsala University Hospital. All participants underwent an echocardiographic examination during the index hospital stay and at 1-year following discharge. Outcome data of time to first heart failure hospitalization or all-cause death was collected up until July 2022. Mean age was 66 years (80% men). Median follow-up was 11.7 (IQR 10.9–12.4) years with 63 observed events. A 1-year improvement in LVEF and GLS was not associated with the outcome [LVEF: adjusted HR 1.03 (CI 95% 0.51–2.05); GLS: adjusted HR 1.05 (CI 95% 0.55–2.04)], whereas a deterioration in GLS was associated with a higher event rate [adjusted HR 5.60 (CI 95% 2.04–15.39)]. Baseline GLS offered a higher C-index than LVEF [0.71 (0.65–0.78) vs. 0.68 (0.61–0.75)].

Improved systolic function after MI did not add incremental long-term prognostic information beyond the baseline systolic function, however, a deterioration in GLS may be associated with worse long-term prognosis. Our results favor a clinical strategy of risk stratification based on GLS rather than LVEF to enhance clinical risk prediction.

Graphical Abstract

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