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Lustosa, R.P.; Fortuni, F.; Bijl, P. van der; Mahdiui, M. el; Montero Cabezas, J.M.; Kostyukevich, M.V.; ... ; Bax, J.J. (2021)

Changes in global left ventricular myocardial work indices and stunning detection 3 months after ST-segment elevation myocardial infarction

Article / Letter to editor
Global left ventricular (LV) myocardial work (MW) indices (GLVMWI) are derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure measurements. Changes in global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) after ST-segment elevation myocardial infarction (STEMI) have not been explored. The aim of present study was to assess the evolution of GLVMWI in STEMI patients from baseline (index infarct) to 3 months' follow-up. Three-hundred and fifty patients (265 men; mean age 61 +/- 10 years) with STEMI treated with primary percutaneous coronary intervention (PCI) and guideline-based medical therapy were retrospectively evaluated. Clinical variables, conventional echocardiographic measures and GLVMWI were recorded at baseline within 48 hours post-primary PCI and 3 months' follow-up. LV ejection fraction (from 54 +/- 10% to 57 +/- 10%, p < 0.001), GWI (from 1449 +/- 451 mm Hg% to...Show moreGlobal left ventricular (LV) myocardial work (MW) indices (GLVMWI) are derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure measurements. Changes in global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) after ST-segment elevation myocardial infarction (STEMI) have not been explored. The aim of present study was to assess the evolution of GLVMWI in STEMI patients from baseline (index infarct) to 3 months' follow-up. Three-hundred and fifty patients (265 men; mean age 61 +/- 10 years) with STEMI treated with primary percutaneous coronary intervention (PCI) and guideline-based medical therapy were retrospectively evaluated. Clinical variables, conventional echocardiographic measures and GLVMWI were recorded at baseline within 48 hours post-primary PCI and 3 months' follow-up. LV ejection fraction (from 54 +/- 10% to 57 +/- 10%, p < 0.001), GWI (from 1449 +/- 451 mm Hg% to 1953 +/- 492 mm Hg%, p < 0.001), GCW (from 1624 +/- 519 mm Hg% to 2228 +/- 563 mm Hg%, p < 0.001) and GWE (from 93% (interquartile range (IQR) 86%-95%) to 95% (IQR 91%-96%), p < 0.001) improved significantly at 3 months' follow-up with no significant difference in GWW (from 101 mm Hg% (IQR 63-155 mm Hg%) to 96 mm Hg% (IQR 64-155 mm Hg %); p = 0.535). On multivariable linear regression analysis, lower values of troponin T at baseline, increase in systolic blood pressure and improvement in LV global longitudinal strain were independently associated with higher GWI and GCW at 3 months' follow-up. In conclusion, the evolution of GWI, GCW and GWE in STEMI patients may reflect myocardial stunning, whereas the stability in GWW may reflect permanent myocardial damage and the development of non-viable scar tissue. (C) 2021 The Authors. Published by Elsevier Inc.Show less
All authors
Lustosa, R.P.; Fortuni, F.; Bijl, P. van der; Mahdiui, M. el; Montero Cabezas, J.M.; Kostyukevich, M.V.; Knuuti, J.; Marsan, N.A.; Delgado, V.; Bax, J.J.
Date
2021-10-15
Journal
American Journal of Cardiology
Volume
157
Pages
15 - 21
DOI
doi:10.1016/j.amjcard.2021.07.012
Link
http://www.ajconline.org/article/S0002914921006706/pdf