Key result
Post-STEMI mildly reduced LVEF is linked to poorer strain and perfusion resembling HFrEF.
Why the study?
The characteristics of heart failure with mildly reduced ejection fraction after STEMI overlap with HFrEF and HFpEF and need further exploration.
Observational (n=119)
No
Absolute Event Rate: -9.9% vs -13.8%
p-value: p=<0.001
In patients with STEMI, those who develop HFmrEF exhibit impaired global longitudinal strain and coronary microcirculation that are comparable to patients with HFrEF, suggesting significant adverse remodeling despite mildly reduced LVEF.
HFmrEF post-STEMI shows functional and microcirculatory impairment akin to HFrEF; leaves open whether intensified monitoring or therapy alters outcomes.
BACKGROUND: The characteristics of heart failure (HF) with mildly reduced ejection fraction (EF) (HFmrEF) overlap with those of HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF) and need to be further explored. This study aimed to evaluate left ventricular (LV) function and coronary microcirculation in patients with mildly reduced ejection fraction after acute ST-segment elevation myocardial infarction (STEMI). METHODS: We enrolled 119 patients with STEMI who had undergone speckle tracking imaging and myocardial contrast echocardiography during hospitalization from June 2016 to June 2021. They were classified into normal, HFmrEF, and HFrEF groups according to their left ventricular EF (LVEF): ≥ 50%, 40-50%, and ≤ 40%, respectively. The data of the HFmrEF group were analyzed and compared with those of the normal and HFrEF groups. RESULTS: HFmrEF was observed in 32 patients (26.9%), HFrEF in 17 (14.3%), and normal LVEF in 70 patients (58.8%). The mean global longitudinal strain (GLS) of all patients was - 11.9 ± 3.8%. The GLS of HFmrEF patients was not significantly different from that of the HFrEF group (- 9.9 ± 2.5% and - 8.0 ± 2.3%, respectively, P = 0.052), but they were both lower than that of the normal group (- 13.8% ± 3.5%, P < 0.001). The HFmrEF group exhibited significantly poorer myocardial perfusion index (1.24 ± 0.33) than the normal group (1.08 ± 0.14, P = 0.005) but displayed no significant difference from the HFrEF group (1.18 ± 0.19, P = 0.486). Moreover, a significant difference in the incidence of regional wall motion (WM) abnormalities in the three groups was observed (P = 0.009), and the WM score index of patients with HFmrEF was 1.76 ± 0.30, similar to that of patients with HFrEF (1.81 ± 0.43, P = 0.618), but poorer than that in the normal group (1.33 ± 0.25, P < 0.001). CONCLUSIONS: GLS is a more sensitive tool than LVEF for detecting LV systolic dysfunction. The LV systolic function, coronary microcirculation, and WM in patients with HFmrEF was poorer than that of patients with normal LVEF, but comparable to that in patients with HFrEF. Patients with HFmrEF after STEMI require more attention and appropriate management.
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Ma et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=119). Mildly reduced ejection fraction (HFmrEF, LVEF 40-50%) vs. Normal LVEF (≥ 50%) and reduced LVEF (HFrEF, ≤ 40%) was evaluated on Global longitudinal strain (GLS) (p=<0.001). Patients with mildly reduced ejection fraction after STEMI exhibited significantly poorer global longitudinal strain (-9.9% vs -13.8%) and myocardial perfusion than those with normal LVEF, resembling patients with HFrEF.
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