ObjectiveTo investigate the factors associated with global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsThe clinical data of 315 hospitalized patients with acute STEMI who underwent percutaneous coronary intervention (PCI) in the First Medical Center of PLA General Hospital from June 2016 to September 2021 were retrospectively collected. After analyzing CMR images of all patients, GLS and other strain parameters were obtained, and then the patients were divided into two groups according to the median GLS. In order to balance gender and age differences, 206 patients were eventually included, GLS>-11.3% group (indicating severely damaged GLS, n=103) and GLS<-11.3% group (n=103). Baseline characteristics, laboratory findings, angiographic parameters, electrocardiogram (ECG) features, and CMR parameters were compared between the groups. Variables showing significant differences were analyzed for correlation with GLS. Multivariate logistic regression and multiple stepwise linear regression analyses were performed to identify factors associated with GLS impairment.ResultsIn the GLS>-11.3% group, the peak levels of creatine kinase-MB (CK-MB) and troponin T (TnT) were significantly higher than in the GLS<-11.3% group (P<0.001). A higher proportion of patients in the GLS>-11.3% group had the culprit vessel in the left anterior descending artery (LAD) and a lower proportion in the right coronary artery (RCA) (P<0.001). Additionally, the GLS>-11.3% group had longer QRS duration (P<0.001) and a higher incidence of pathological Q waves (P=0.001). Regarding CMR parameters, the GLS>-11.3% group exhibited larger global circumferential strain (GCS), infarct size (IS), and end-systolic volume (ESV), as well as lower global radial strain (GRS) and left ventricular ejection fraction (LVEF), (P<0.001). Multivariate logistic regression indicated that peak TnT (OR=1.092, P=0.001), culprit vessel LAD (OR=3.744, P<0.001), and QRS duration (OR=1.026, P<0.001) were significantly associated with severely impaired GLS. Linear regression analysis showed that the logarithmic value of peak TnT, the square root of culprit vessel LAD, and QRS duration were linearly related to GLS values, with a statistically significant regression model (adjusted R²=0.301, P<0.001), explaining 30.1% of the variation in GLS.ConclusionElevated peak TnT, prolonged QRS duration, and the LAD culprit vessel are significantly associated with severe GLS impairment in STEMI patients, indicating more extensive myocardial infarction and worse left ventricular function.

acute ST-segment elevation myocardial infarction;cardiac magnetic resonance;global longitudinal strain