Low triiodothyronine syndrome patients had reduced left atrial conduit strain rate and increased LA volume index, and LA conduit strain rate and reservoir strain were independent predictors of major adverse cardiac events over 10 years after STEMI.
Observational (n=140)
No
Do left atrial deformation parameters assessed via speckle-tracking echocardiography predict long-term adverse outcomes in post-STEMI patients, particularly those with low triiodothyronine syndrome?
Left atrial deformation parameters, specifically reservoir strain and conduit strain rate, are significant independent predictors of long-term MACEs and atrial fibrillation in post-STEMI patients.
Effect estimate: Multivariate logistic regression: LA conduit phase strain rate OR 9.971 (95% CI 8.72–11.34), LA volume index OR 1.186 (95% CI 0.84–1.26), LA reservoir strain OR 0.958 (95% CI 0.72–1.27), LVEF OR 0.944 (95% CI 0.81–1.32); fT3 < 3.2 pmol/L predictive factor for MACEs (specificity 0.660)
p-value: p=LA conduit strain rate p=0.008; LA volume index p=0.004; LA reservoir strain p=0.042; LVEF p=0.021
Background: Acute myocardial infarction (AMI) management has reduced in-hospital mortality, yet heart failure (HF) and atrial fibrillation (AF) remain common long-term complications. Left atrial (LA) function, assessed via speckle-tracking echocardiography (STE), provides sensitive markers of cardiac remodeling. This study aims to investigate the prognostic value of LA deformation parameters and their significance for long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI), particularly in relation to low triiodothyronine (T3) syndrome. Methods: A retrospective study enrolled 140 first-onset STEMI patients treated with primary percutaneous coronary intervention. Thyroid hormone concentrations were measured within 24 h of admission, and patients were classified into low T3 (free triiodothyronine (fT3) < 3.2 pmol/L, n = 44) and control groups (n = 96). Echocardiography and STE were performed within 72 h and repeated after 6 months. LA reservoir strain and conduit and contractile strain rate parameters were analyzed. Long-term outcomes, including AF, rehospitalization, HF, major adverse cardiac events (MACEs), and all-cause death, were assessed after 10 years. Results: Patients with low T3 syndrome were older, with higher inflammatory markers (P = 0.03) and reduced LA conduit strain rates during the acute phase (P = 0.04). After 6 months, LA volume increased significantly in both groups, but more prominently in low T3 patients (P = 0.03). Reduced LA reservoir strain (area under the curve (AUC), 0.721; P = 0.012) and conduit strain rate (AUC, 0.621; P = 0.012) were strong predictors of MACEs and AF, respectively. Logistic regression identified the LA conduit strain rate, LA reservoir strain, LA volume index, and left ventricular ejection fraction as independent predictors of adverse outcomes. Conclusions: STE-derived LA deformation parameters provide valuable prognostic information in post-STEMI patients. The LA reservoir strain and LA conduit strain rate are significant predictors of MACEs, while LA global longitudinal strain identifies patients at risk of HF. Early STE evaluation can enhance risk stratification and guide management.
Jankauskienė et al. (2026) conducted an observational in Patients aged 18-80 years with first-onset ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, without thyroid pathology or prior MI (n=140). Left atrial deformation parameters assessed by speckle-tracking echocardiography (STE) vs. Comparison between low T3 syndrome group (fT3 < 3.2 pmol/L) and control group (fT3 ≥ 3.2 pmol/L) was evaluated on Major adverse cardiac events (MACEs), including heart failure, atrial fibrillation, rehospitalization, repeated MI, and all-cause death over 10 years (Multivariate logistic regression: LA conduit phase strain rate OR 9.971 (95% CI 8.72–11.34), LA volume index OR 1.186 (95% CI 0.84–1.26), LA reservoir strain OR 0.958 (95% CI 0.72–1.27), LVEF OR 0.944 (95% CI 0.81–1.32); fT3 < 3.2 pmol/L predictive factor for MACEs (specificity 0.660), p=LA conduit strain rate p=0.008; LA volume index p=0.004; LA reservoir strain p=0.042; LVEF p=0.021). Low triiodothyronine syndrome patients had reduced left atrial conduit strain rate and increased LA volume index, and LA conduit strain rate and reservoir strain were independent predictors of major adverse cardiac events over 10 years after STEMI.
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