Usefulness of non-invasive myocardial work to predict left ventricular recovery and acute complications after acute anterior myocardial infarction treated by primary percutaneous intervention

Abstract

Predicting left ventricular (LV) recovery after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. To evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV recovery and in-hospital complications after STEMI. In total, 93 consecutive patients with anterior STEMI (mean age, 59 ± 12 years) treated by primary percutaneous intervention (PCI) underwent transthoracic echocardiography (TTE) within 24–48 hours after angioplasty and a median of 92 days at follow-up. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Segmental LV recovery was defined as a normalization of segmental wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF) greater than 5% in patients with baseline LVEF < 50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus. In total, 1642 segments were studied and MW was impaired in infarct segments, more severely in no recovering versus recovering segments (MW index, constructive MW, MW efficiency, all, P < 0.01). Furthermore, global MW was significantly correlated to acute and follow-up LVEF and global longitudinal strain (GLS) (all, P < 0.01). Constructive MW was the best index to predict segmental ( P < 0.01 versus MW index, MW efficiency, and wasted work), and global recovery ( P < 0.05 versus GLS) with an independent association (all, P < 0.01). Moreover, global constructive MW was independently associated to in-hospital complications, which occurred in 18 patients ( P < 0.01). In patients with anterior STEMI treated by PCI, acute constructive MW is an independent predictor of segmental and global LV recovery, as well as in-hospital complications.