Key result
Structural and functional recovery diverge in ~30% of post-STEMI patients despite moderate correlation.
Why the study?
Ventricular recovery after STEMI is commonly assessed using structural or functional criteria, which may capture different aspects of recovery, but their combined classification and additional myocardial mechanics information were not well characterized.
Do structural and functional criteria capture different aspects of ventricular recovery in patients after first STEMI treated with PCI?
Cohort (n=101)
Do structural and functional criteria capture different aspects of ventricular recovery in patients after first STEMI treated with PCI?
Structural and functional recovery after STEMI are complementary rather than interchangeable, highlighting the value of assessing both volumetric and ejection-fraction criteria.
Answers are grounded in this paper and cite their sources.
Cross-classification of volumetric and functional recovery may delineate distinct post-STEMI phenotypes; leaves open whether mechanics enhance risk stratification.
Background/Objectives: Ventricular recovery after ST-segment elevation myocardial infarction (STEMI) is commonly assessed using either structural (volumetric) or functional (ejection-fraction) criteria, although these may capture different aspects of recovery. We examined whether their cross-classification identifies distinct recovery patterns and whether myocardial mechanics and left atrial function provide additional information. Methods: We prospectively followed 101 patients with first STEMI and single-vessel coronary artery disease treated with PCI. Echocardiography was performed 12–24 h after reperfusion and at 12 ± 2 months. Structural recovery (≥15% reduction in 3D LV end-systolic volume) and functional recovery (≥5-point absolute LVEF increase) were cross-classified into four recovery patterns. Results: Among 53 patients with complete paired measurements, 10 (18.9%) showed concordant recovery, 7 (13.2%) isolated structural recovery, 9 (17.0%) isolated functional recovery, and 27 (50.9%) no recovery; 30.2% therefore showed discordant recovery. The no-recovery group was heterogeneous, including both volumetric deterioration and stable or improving volumes below the recovery threshold. Continuous changes in 3D-ESV and LVEF were only moderately correlated (ρ = 0.353, p = 0.0095), and discordance persisted in sensitivity analyses. Myocardial mechanics and LASR did not differentiate recovery patterns, but several of these baseline markers showed exploratory associations with clinical outcomes after false-discovery-rate correction. Conclusions: Structural and functional recovery after STEMI are complementary rather than interchangeable, and this discordance persisted across extensive sensitivity analyses; however, assignment of individual patients to specific recovery categories remained sensitive to the chosen thresholds and LVEF measurement method. Myocardial mechanics and LASR may provide additional information about clinical expression.
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Craciun-Mirescu et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=101). Cross-classification of structural and functional recovery was evaluated on Cross-classification of structural (≥15% reduction in 3D LV end-systolic volume) and functional recovery (≥5-point absolute LVEF increase). Among 53 patients with paired measurements after STEMI, 30.2% showed discordant structural and functional recovery, with continuous changes in 3D-ESV and LVEF only moderately correlated (p=0.0095).
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