Key result
Post-PCI STEMI patients show ~35% improvement in global work index at 3 months.
Why the study?
Changes in global left ventricular myocardial work indices after STEMI have not been explored.
How do global left ventricular myocardial work indices change from baseline to 3 months follow-up in STEMI patients treated with primary PCI?
Observational (n=350)
How do global left ventricular myocardial work indices change from baseline to 3 months follow-up in STEMI patients treated with primary PCI?
In STEMI patients treated with primary PCI, global work index, constructive work, and work efficiency improve significantly at 3 months, likely reflecting recovery from myocardial stunning, while wasted work remains stable.
May track post-STEMI recovery; leaves open incremental prognostic value of myocardial work indices.
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 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.
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Lustosa et al. (2021) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=350). 3 months' follow-up post-STEMI vs. Baseline (within 48 hours post-primary PCI) was evaluated on Global work index (GWI) (p=<0.001). In patients with STEMI treated with primary PCI, global work index significantly improved from baseline to 3 months (1449 vs 1953 mm Hg%, p<0.001), whereas global wasted work remained stable.
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