Key result
Lack of LVEF recovery after STEMI is linked to ~8-fold higher 6-month MACE.
Why the study?
Up to 50% of patients do not achieve significant LVEF recovery after PPCI for STEMI, prompting the need to identify echocardiographic predictors for recovery and evaluate early follow-up echocardiography for risk assessment.
Does a multiparametric echocardiographic approach including strain parameters predict LVEF recovery and MACE in STEMI patients after primary PCI?
Observational (n=101)
Does a multiparametric echocardiographic approach including strain parameters predict LVEF recovery and MACE in STEMI patients after primary PCI?
Absolute Event Rate: 4.1% vs 32.7%
p-value: p=<0.001
Speckle tracking echocardiography, specifically GLS and GCS, along with E/e', provides significant prognostic value for predicting LV recovery and 6-month MACE in STEMI patients post-PPCI.
May aid post-STEMI risk stratification; leaves open whether strain parameters should guide therapy.
PURPOSE: Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. METHODS: One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6 weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. RESULTS: The mean change of EF was 8.04 ± 3.32% in group I versus -.39 ± 5.09 % in group II (p < .001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6 weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p < .001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. CONCLUSIONS: Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.
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Yehia et al. (2023) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=101). Echocardiographic assessment (GLS, GCS, E/e') vs. Non-recovery of LVEF was evaluated on Composite MACE at 6 months (p=<0.001). Lack of LVEF recovery after STEMI was associated with significantly higher 6-month MACE (32.7% vs 4.1%, p<0.001), with baseline GLS, E/e', and EF recovery acting as strong independent predictors.
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