After ST-segment elevation myocardial infarction (STEMI), follow-up imaging is currently recommended only in patients with left ventricular ejection fraction (LVEF) <40%. LV global longitudinal strain (GLS) showed to improve risk stratification over LVEF in these patients, but has not been thoroughly studied during follow-up. Aim of this study was to explore the changes in LVGLS after STEMI and their potential prognostic value. Data were analyzed from an ongoing STEMI registry. Echocardiography was performed during the index hospitalization and one year after STEMI; LVGLS was expressed as absolute value and the relative LVGLS change (ΔGLS) was calculated. The study endpoint was all-cause mortality. A total of 1409 STEMI patients (age 60±11 years; 75% men), who survived at least one year after STEMI and underwent echocardiography at follow-up, were included. At one year follow-up, LVEF improved from 50±8% to 53±8% (p<0.001) and LVGLS from 14±4% to 16±3% (p7%. Cumulative 10-year survival was 91% in patients with ΔGLS improvement or a non-significant decrease, versus 85% in patients with ΔGLS decrease of >7% (p=0.001). On multivariate Cox regression analysis, ΔGLS decrease >7% remained independently associated with the endpoint (HR 2.5 (95% CI 1.5 - 4.1); p<0.001) after adjustment for clinical and echocardiographic parameters. A significant decrease in LVGLS one year after STEMI was independently associated with long-term all-cause mortality and might help further risk stratification and management of these patients during follow-up.

Evidence on cardiac remodeling, left ventricular (LV) function recovery, medication use and outcomes in older ST-segment elevation myocardial infarction (STEMI) patients is limited. We examined these aspects at baseline and evolution one year post-infarct in patients aged ≥ 80 versus < 80.STEMI registry data were retrospectively analyzed. The older subgroup included patients aged ≥ 80 years at index hospitalization. Echocardiography was performed at baseline and one year after STEMI. LV remodeling was defined as > 20% relative increase in the LV end-diastolic volume. One-year cardiovascular outcomes and five-year all-cause mortality are reported.Study included 2178 patients; 132 (6.1%) were aged ≥ 80. Older patients had worse baseline LV ejection fraction (47.2 ± 9.6% versus 49.8 ± 8.2%; p < 0.001) and experienced more adverse LV remodeling (29% versus 19%; p = 0.024). Nevertheless, LV function improved similarly in both groups. Beta-blocker and renin-angiotensin-aldosterone system inhibitor use was lower (86.4% versus 94.2%; p < 0.001 and 90.2% versus 96.5%; p < 0.001, respectively) but diuretic prescription higher (18.2% versus 8.1%; p < 0.001) in older patients. One year post-infarct beta-blocker and renin-angiotensin-aldosterone system inhibitor use decreased and was similar in both groups, but older patients continued to receive more diuretics and suffered higher heart failure hospitalization rates (7.0% versus 2.6%; p = 0.006). Five-year mortality was 25.8% in older versus 4.3% in younger patients (log-rank χ2 133.2; p < 0.001).Older patients experienced more adverse LV remodeling, received less beta-blockers and renin-angiotensin-aldosterone system inhibitors but more diuretics at discharge and one year, compared to younger patients. Nevertheless, LV function recovered similarly in both groups.

New-onset atrial fibrillation (AF) affects up to 21% of ST-segment elevation myocardial infarction (STEMI) patients. The value of LA reservoir strain to predict new-onset AF in a STEMI population has not been thoroughly investigated. We aimed to explore the incremental value of LA reservoir strain for predicting new-onset AF post-STEMI. Data were analyzed retrospectively from an ongoing STEMI registry. LA reservoir strain < 23% on transthoracic echocardiography was used as threshold for impaired LA function. The endpoint was new-onset AF. In total, 1238 patients (age 60 ± 12 years, 75% male) were included. After a median follow-up of 23 months, 92 (7.4%) patients developed new-onset AF. A similar prevalence of LA volume index ≥ 34 ml/m² was seen between post-STEMI patients who developed new-onset AF and those who did not. In contrast, impaired LA reservoir strain was 1.5 times more common in individuals who developed AF (72% versus 48%; p < 0.001). Cumulative, event-free survival rates at five years in patients with preserved versus impaired LA reservoir strain were 93% versus 84%, respectively (log-rank χ2 = 19.81; p < 0.001). On multivariate Cox regression analysis LA reservoir strain remained significantly associated with new-onset AF (HR 0.97 (95% CI: 0.94–0.99); p = 0.025). Addition of LA reservoir strain provided incremental prognostic value over baseline clinical and echocardiographic risk markers (χ2 56.93 vs. 59.98; p = 0.013). Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF after adjusting for clinical and echocardiographic risk factors. Graphical abstract Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF.

Background/Objectives: Ischemia with non-obstructive coronary arteries (INOCA) remains an underdiagnosed and undertreated condition due to the extensive diagnostic testing required and heterogeneous pathophysiology of different endotypes, each of which require tailored treatment. This study aimed to explore the effect of intracoronary physiology testing-based endotype-specific medical therapy on quality of life in patients with INOCA. Methods: Intracoronary physiology testing was performed in patients presenting with cardiac symptoms, evidence of significant ischemia on non-invasive testing, and non-obstructive epicardial coronary arteries. Microvascular angina (MVA) was defined as coronary flow reserve ≤ 2.5 and an index of microvascular resistance ≥ 25. Vasospastic angina (VSA) was defined as a >90% vasoconstriction of an epicardial artery during acetylcholine provocation test in the presence of ischemic electrocardiogram changes and chest pain. Quality of life was evaluated using the Seattle Angina Questionnaire 7 (SAQ-7) before the start of new treatment and at the three months follow-up. Results: The total study population consisted of 35 patients (80% women), of whom MVA was observed in 19 (54.3%), VSA in 9 (25.7%), and the combination of MVA and VSA in 3 (8.6%) cases. Four patients (11.4%) had no pathology on intracoronary physiology testing detected. High rates of dyslipidemia (100%), arterial hypertension (85.7%), diabetes (17.1%), and depression and anxiety (34.3%) were documented. In the isolated MVA and VSA groups, adjustment of medical therapy resulted in an improvement in the SAQ-7 summary score at 3 months (p < 0.001 and p = 0.007, respectively). There was no change of SAQ-7 summary score in the mixed endotype group (p = 0.11). Conclusions: Adjustment of medical therapy according to intracoronary physiology testing-based phenotype resulted in improved quality of life as assessed by the SAQ-7. Our findings highlight the importance of invasive testing in patients with clinically suspected INOCA.