CMR-derived LV GLS is the strongest functional parameter associated with adverse LV remodelling in anterior STEMI patients, remaining significant after adjusting for clinical risk factors, but not beyond infarct size and MVO, indicating that its prognostic value is largely mediated by myocardial injury burden.
LV global longitudinal strain (GLS) was the strongest predictor of adverse LV remodelling after anterior STEMI.
The prognostic value of LV GLS for adverse LV remodelling is largely mediated by myocardial injury burden (infarct size and MVO).
Left atrial (LA) strain and left atrioventricular coupling index (LACI) did not have additional prognostic value for adverse LV remodelling.
The study was a post-hoc analysis of the EURO-ICE trial including 200 patients with anterior wall STEMI who underwent CMR at baseline and 3-month follow-up.
Traditional LV indices outperformed novel CMR-derived LA parameters in predicting adverse LV remodelling after STEMI.
This research examined which heart function measurements obtained from cardiac MRI scans best predict whether the heart will worsen in size and shape (called 'adverse left ventricular remodelling') in the months following a major type of heart attack called STEMI. The study analyzed data from 200 patients who had a heart attack affecting the front wall of the heart, comparing measurements taken shortly after the heart attack to those taken three months later. The researchers tested several newer measurements involving the heart's upper left chamber (the left atrium) against a more established measurement of how well the main pumping chamber squeezes (called global longitudinal strain, or GLS). The study found that the traditional measure of the left ventricle's squeezing function (LV GLS) was the strongest predictor of whether the heart would remodel adversely. However, when the researchers accounted for the size of the heart attack scar and a phenomenon called microvascular obstruction (where tiny blood vessels in the heart remain blocked even after the main artery is opened), LV GLS lost its predictive power. This suggests that GLS is mainly useful because it reflects how much heart muscle was damaged, rather than providing independent information. The newer left atrial measurements (LA strain and LACI) did not show any meaningful ability to predict adverse remodelling. This research suggests that when cardiac MRI with contrast dye is performed after a heart attack, measuring the infarct size and microvascular obstruction provides the most important prognostic information, and the newer atrial measurements do not add extra value. The established LV GLS measurement may still be useful in situations where contrast dye cannot be administered to the patient, as it can still capture information about myocardial injury burden without requiring contrast.
Yosofi B, Zelis J, Raafs A, Teeuwen K, Berry C, Mangion K, et al.. (2026). Traditional left ventricular indices outperform novel cardiovascular magnetic resonance-derived left atrial parameters in predicting adverse left ventricular remodelling after ST-segment elevation myocardial infarction.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134587