Usefulness of Noninvasive Myocardial Work to Predict Left Ventricular Recovery and Acute Complications after Acute Anterior Myocardial Infarction Treated by Percutaneous Coronary Intervention

Abstract

Predicting left ventricular recovery (LVR) after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. Our objective was to evaluate the usefulness of noninvasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and in-hospital complications after STEMI. Ninety-three patients with anterior STEMI (mean age, 59±12years) treated by percutaneous coronary intervention (PCI) were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24-48hours after PCI and a median of 92days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the noninvasive arterial pressure. Segmental LVR was defined as a normalization of wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF)>5% in patients with baseline LVEF≤50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus. Segmental MW was impaired in infarct segments, more severely in nonrecovering versus recovering segments (P<.01). Furthermore, global constructive MW was significantly correlated with follow-up LVEF (r=0.58) and global longitudinal strain (r=-0.67; all P<.01). Constructive MW was the best index to predict segmental (P<.01 vs MW index, MW efficiency, and wasted work) and global recovery (P<.05 vs global longitudinal strain) with an independent association (odds ratio=1.17, 95% CI, 1.13-1.20, and odds ratio=1.43, 95% CI, 1.18-1.68, respectively; all P<.001). Moreover, global constructive MW was more severely impaired in patients with in-hospital complications (n=16; P<.01). In patients with anterior STEMI treated by PCI, constructive MW is an independent predictor of segmental and global LVR and is significantly impaired in patients with in-hospital complications.