BackgroundPatients with type 2 diabetes (T2DM) experience profoundly poor outcomes after myocardial infarction (MI), a risk not fully captured by left ventricular ejection fraction (LVEF). Subclinical mechanical dysfunction, electrical instability, and persistent neurohumoral activation are common in T2DM post-MI, but their combined prognostic value in a Southeast Asian population is unknown.This study sought to determine the independent and incremental prognostic value of echocardiographic global longitudinal strain (GLS), 24-hour Holter-detected arrhythmias, and cardiac biomarkers (high-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide) for predicting 12-month major adverse cardiovascular events (MACE) in T2DM patients post-MI in Myanmar.

We conducted a prospective, single-center cohortstudy at the 700 Bedded Military Hospital a tertiary care hospital in Pyin OoLwin, Myanmar. We enrolled 200 T2DM patients with LVEF >40% stabilized afteran acute MI. Pre-discharge, all patients underwent 2D speckle-trackingechocardiography for GLS, 24-hour Holter monitoring, and biomarker assessment(hs-cTnT, NT-pro BNP). The primary endpoint was 12-month MACE, a composite ofcardiovascular death, non-fatal recurrent MI, or non-fatal ischemic stroke.

At 12 months, MACE occurred in 36 patients (18.0%). In an adjusted multivariable Cox regression model, impaired GLS (HR:1.18 per 1% worsening; 95% CI: 1.09-1.28), the presence of non-sustained ventricular tachycardia (NSVT) (HR: 2.41; 95% CI: 1.52-3.83), and log-transformed NT-pro BNP (HR: 1.55 per 1-SD increase; 95% CI: 1.24-1.93) were all significant, independent predictors of MACE (all p< 0.001). LVEF was not an independent predictor (p = 0.34). Adding this multi-marker panel to a base model (clinical factors + LVEF) significantly improved the C-statistic (from0.64 to 0.79; p < 0.01) and net reclassification (NRI: 0.38; p < 0.001).  Full Model = Base + GLS + Holter + Biomarkers.C-Statistic = Concordance Statistic 

In T2DM patients post-MI with relatively preserved LVEF, a multi-modality strategy integrating GLS, NSVT, and NT-pro BNP provides significant, independent, and incremental prognostic information over traditional risk factors. This approach identifies a high-risk cohort in Myanmar who may warrant more aggressive secondary prevention.