Noninvasive Myocardial Work Indices 3 Months after ST-Segment Elevation Myocardial Infarction: Prevalence and Characteristics of Patients with Postinfarction Cardiac Remodeling

Abstract

Background: Assessment of left ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) is pivotal for patient management. Noninvasive myocardial work indices obtained from echocardiography-derived strain-pressure loops provide a new tool that permits characterization of LV mechanics. We aimed at characterizing myocardial work indices in patients with LV remodeling after STEMI versus patients without remodeling. Methods: Six-hundred STEMI patients were retrospectively analyzed (456 men, mean age: 61 6 11 years) and divided according to the presence of LV remodeling 3 months after the index admission ($20% increase in LV end-diastolic volume). Noninvasive myocardial work indices were measured at 3 months after STEMI. Results: LV remodeling was observed in 150 patients (25%) who showed more impaired global myocardial work indices compared with their counterparts:

Changes in Global Left Ventricular Myocardial Work Indices and Stunning Detection 3 Months After ST-Segment Elevation Myocardial Infarction

“…3 Various imaging techniques have been used to detect myocardial stunning (viability) after myocardial infarction. 4,5 Recently, global LV myocardial work (MW) indices (GLVMWI) 6 have been applied to STEMI patients 7 to evaluate LV systolic function (and relate to myocardial glucose metabolism 6 ). The changes in GLVMWI between the index event and follow-up after STEMI have not been extensively investigated and may provide further insights into the use of echocardiography to predict LV functional recovery after STEMI.…”

Inhaled Nitric Oxide Preserves Ventricular Function During Resuscitation Using a Percutaneous Mechanical Circulatory Support Device in a Porcine Cardiac Arrest Model – An Echocardiographic Myocardial Work Analysis

“…Although treatment guidelines recommend inotropes and vasopressors, many studies have demonstrated their detrimental side effects [22]. In the early phase of resuscitation, treatments aim to augment or stabilize cardiac output, allowing minimal end-organ perfusion, and reducing or preventing hypoxic/ischemic injury [12][13][14]. However, these treatments cause increased myocardial stress and oxygen demand when oxygen supply is low [23,24].…”

“…The RV-GWE increased signi cantly in the 20ppm group at 5h post-ROSC compared to the 0ppm group (80±5.2 vs. 73±5.7, p=0.042, respectively) Diagnostic utilization of pressure-strain loops Figure 7A is a representative overlay of the PS-loops of the LV. An acute injury following iCPR initiation is demonstrated by narrowing of the PS-loop (a sign of loss in maximally generated strain), thus explaining the ventricle´s inability to generate su cient pressure [13][14][15][16][17].…”

“…Using GWI and GWW enabled the early identi cation of patients with acute coronary occlusion with non-ST-elevation [4]. Ischemia induces changes in myocardial contraction, and it has been shown that patients with subclinical ischemia have a dyssynchronous contraction and increased GWW [14].…”

Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

“…More reduced GWI, GCW, and GWE and more increased GWW, instead, have been detected in STEMI patients who developed LV ischemic remodeling at 3-months follow-up [ 25 ]. Consistent with these results, El Mahdiui et al has shown that GWE is lower in patients who have undergone primary percutaneous coronary intervention for STEMI compared with healthy controls and those with cardiovascular risk factors, and even more impaired in presence of HFrEF [ 24 ].…”