Global longitudinal strain by speckle-tracking echocardiography predicts left ventricular remodelling after anterior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract

Objective: Despite reperfusion, LV remodelling post-AMI remains a major concern. We evaluated whether speckle-tracking GLS predicts 2‑month remodelling in first anterior STEMI patients treated with primary PCI.

Methods: We prospectively studied 50 first anterior STEMI patients. Within 48 h of admission, comprehensive 2D echocardiography with speckle-tracking GLS was performed; LVEDV, LVESV, and LVEF were reassessed at 2 months. Remodelling was defined as a>20% increase in LVEDV.

Results: Remodelling occurred in 23 patients (46%). Remodellers had significantly longer ischaemia (18.26±9.1 vs 4.48±2.1 h), higher LVESV (67.39±22.6 vs 41.18±16.8 mL), lower LVEF (27.95±9.8 vs 49.66±6.8%), higher E/e′ (14.04±1.3 vs 7.48±1.4), and worse GLS (–7.82±2.6 vs –15.03±2.8%; all p=0.001). ROC analysis identified GLS < –14% as predictive, yielding 100% sensitivity, 81.5% specificity, and 90% accuracy (AUC=0.969).

Conclusion: Speckle-tracking GLS aids early risk stratification for LV remodelling after anterior STEMI. A threshold of > –14% (less negative) flags high‑risk patients, though multi‑centre validation is required before routine adoption