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

Background: Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV global longitudinal strain (GLS), left atrial (LA) strain, and left atrioventricular coupling index (LACI) are promising, but it remains unclear which CMR-derived functional parameter is optimal. This study aimed to investigate the prognostic significance of atrial and ventricular function parameters to predict early adverse LV remodelling in patients with anterior STEMI. Methods and results: A post-hoc analysis of the EURO-ICE trial was performed, including 200 patients with anterior wall STEMI who underwent cardiovascular magnetic resonance (CMR) at baseline and 3-month follow-up. Predictors of adverse LV remodelling were identified. LV GLS was the strongest predictor, respectively odds ratio (OR) 1.162; 95% confidence interval (CI) 1.060–1.274; p = 0.001 and OR 1.155; 95% CI 1.007–1.326; p = 0.040. Its significance remained after adjusting for clinical risk factors (OR 1.216; 95% CI 1.096–1.349; p < 0.001), but not after adjusting for infarct size and microvascular obstruction (MVO) (OR 1.063; 95% CI 0.959–1.178; p = 0.246). LA strain and LACI did not have additional prognostic value. Conclusions: CMR-derived LV GLS is the strongest functional parameter associated with adverse LV remodelling 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. No significant association was found between LA strain or LACI and adverse LV remodelling. LV GLS may add value when contrast agents cannot be used.