Cor Vasa 2025, 67(6):698-707

Speckle Tracking Echocardiography Predicts Left Ventricular Remodeling after Acute ST-Segment Elevation Myocardial Infarction in Patients Undergoing Primary PCI

Ahmed A. Elamragy, Irini Samuel, Ahmed Hassan, Reda Hussein Diab, Mohamed Abdel Ghany, Ahmed Mohsen
Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt

Purpose: Left ventricular remodeling (LVR) following ST-segment elevation myocardial infarction (STEMI) significantly impacts prognosis. Although three-dimensional echocardiography (3D-echo) accurately assesses LV volume, early LVR prediction remains challenging. This study evaluated whether baseline global longitudinal strain (GLS), a non-invasive echocardiographic marker, predicts LVR six months post-STEMI in patients treated with primary percutaneous coronary intervention (PPCI).

Methods: This prospective observational study included 53 first-time STEMI patients who underwent PPCI and completed a six-month echocardiographic follow-up. LV function was assessed within 48 hours and at six months using 2D echocardiography, speckle tracking echocardiography (STE), and 3D-echo. LVR was characterized as a ≥15% rise in LV end-diastolic volume (LVEDV) during follow-up 3D-echo. Patients were grouped based on LVR status, and potential LVR predictors were statistically analyzed.

Results: LVR occurred in 19 patients (35.8%). At baseline, LVR patients had larger LV volumes, lower ejection fraction, higher wall motion score index, and lower GLS (-12.3% vs. -18.7%, p <0.001). ROC analysis identified GLS > -14.8% as the optimal LVR predictor (AUC: 0.796, sensitivity: 78.95%, specificity: 82.35%). Multivariate analysis confirmed GLS > -14.8% (p <0.001) and TIMI flow grade (p = 0.013) as independent predictors.

Conclusion: GLS measured within 48 hours of STEMI strongly predicts LVR at six months. Its accessibility and predictive power may support its role in post-STEMI early risk stratification.

Keywords: Global longitudinal strain left ventricular remodeling, Primary PCI, STEMI, 3D echocardiography

Received: April 19, 2025; Revised: July 5, 2025; Accepted: July 6, 2025; Prepublished online: June 2, 2012; Published: December 15, 2025  Show citation

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Elamragy AA, Samuel I, Hassan A, Diab RH, Ghany MA, Mohsen A. Speckle Tracking Echocardiography Predicts Left Ventricular Remodeling after Acute ST-Segment Elevation Myocardial Infarction in Patients Undergoing Primary PCI. Cor Vasa. 2025;67(6):698-707.
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