Key result
Lower LVEF after STEMI is linked to progressively worse LV and LA mechanics.
Why the study?
LVEF does not fully capture myocardial contractile function or the interplay between LV and LA mechanics after STEMI, which can be evaluated using advanced echocardiographic techniques.
How do left ventricular and left atrial mechanics differ across LVEF categories in patients with first STEMI treated with primary PCI?
Observational (n=448)
How do left ventricular and left atrial mechanics differ across LVEF categories in patients with first STEMI treated with primary PCI?
Advanced echocardiographic assessment reveals a continuum of progressive left ventricular and left atrial mechanical impairment in post-STEMI patients that correlates with declining LVEF.
Strain metrics track LVEF decline post-STEMI; extends prior observations but remains hypothesis-generating for risk stratification.
Background ST-segment elevation myocardial infarction (STEMI) results in varying degrees of left ventricular (LV) dysfunction, which can influence both left ventricular and left atrial (LA) mechanics. While LV ejection fraction (LVEF) remains a cornerstone for post-STEMI risk stratification, it does not fully capture myocardial contractile function or the interplay between LV and LA mechanics. Advanced echocardiographic techniques, including speckle-tracking strain analysis and myocardial work assessment, provide deeper insights into myocardial deformation, energetic efficiency, and the compensatory role of the left atrium. Objective This prospective observational study aimed to evaluate and compare LV and LA mechanics across three distinct groups of STEMI patients categorized by LVEF: reduced EF (rEF; LVEF <40%), mildly reduced EF (mrEF; LVEF 40–49%), and preserved EF (pEF; LVEF ≥50%). Methods Conventional and advanced 2D speckle-tracking echocardiography were performed according to EACVI guidelines at discharge from the CCU and analyzed using dedicated software. The analyzed LV parameters included global longitudinal strain (LV GLS), peak systolic dispersion (LV PSD), and myocardial work indices: global work index (LV GWI), global constructive work (LV GCW), global wasted work (LV GWW), and global work efficiency (LV GWE). Left atrial function was assessed through left atrial volume index (LAVi), left atrial ejection fraction (LA EF), and left atrial strain indices: reservoir phase strain (LAS-r), conduit phase strain (LAS-cd), and contraction phase strain (LAS-c). Results A total of 448 patients with first STEMI, successfully treated with primary PCI, were included. Results are summarized in Table 1. LV and LA strain parameters differed significantly across the three groups, with progressive myocardial deformation impairment as LVEF declined. Patients with rEF exhibited the most pronounced dysfunction, including reduced LV GLS, altered myocardial work indices (GWI, GCW, GWE), and impaired LAS-r, reflecting disturbed LA-LV interaction. The mrEF group demonstrated intermediate values, reinforcing a continuum of myocardial impairment between pEF and rEF. Myocardial work analysis provided additional insights beyond conventional echocardiography, highlighting differences not captured by EF alone. Conclusion This study underscores the importance of comprehensive myocardial mechanics assessment in STEMI patients, providing valuable insights into early post-infarction LV and LA changes that may aid risk stratification and guide therapeutic strategies for optimized clinical management.
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Zamaklar et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=448). Reduced LVEF (<40%) and mildly reduced LVEF (40-49%) vs. Preserved LVEF (≥50%) was evaluated on Left ventricular and left atrial mechanics (including LV GLS, myocardial work indices, and LA strain). In 448 STEMI patients, reduced LVEF (<40%) was associated with the most pronounced LV and LA dysfunction, including reduced LV GLS and impaired LA strain, compared to higher LVEF categories.
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