Association between left ventricular global longitudinal strain and acute pulmonary edema caused by increased left ventricular afterload in patients with STEMI

Acute pulmonary edema (APE) is common complication after ST elevation myocardial infarction (STEMI) and often associated with poor prognosis. It is usually caused by decreases of left ventricular contractility and subsequent increase of left ventricular afterload. In this study we aimed to determine association between left ventricular global longitudinal strain (GLS) parameter and APE caused by increased left ventricular afterload. We chose patients with STEMI and who were treated by primary PCI in this study. Two dimensional speckle tracking echocardiography was used to assess left ventricular GLS. Study endpoint was APE caused by increased left ventricular afterload. Univariable and multivariable logistic regression analysis was used to determine association between GLS and APE. A total of 524 patients were enrolled. Mean age was 60 ± 13 years old and majority of patients were male 444 (84.7%). During admission, APE was occurred in 15 (2.9%) patients. Univariable logistic regression analysis showed GLS is significantly associated with APE and every 1 unit change of GLS is associated with 1.34 times increased probability of having APE (OR 1.34, 95% CI 1.17-1.53, p<0.001). After adjustment of clinical, angiographic and conventional echocardiographic indices, left ventricular GLS was independently associated with APE (OR 1.25, 95% CI 1.06-1.46, p<0.01). Predictive capacity of left ventricular GLS was better than LVEF (c-statistic 0.824, 95% CI 0.719-0.929, p<0.001). Speckle tracking derived GLS is strong and independent predictor of APE caused by increased left ventricular afterload in patients with STEMI after primary PCI. Prognostic capacity of GLS is better than LVEF.