Usefulness of non-invasive myocardial work to predict left ventricular recovery and acute complications after acute anterior myocardial infarction treated by primary percutaneous intervention - 09/01/21
Résumé |
Predicting left ventricular (LV) recovery after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance.
Objective |
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.
Methods |
In total, 93 consecutive patients with anterior STEMI (mean age, 59±12 years) treated by primary percutaneous intervention (PCI) underwent transthoracic echocardiography (TTE) within 24–48hours 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.
Results |
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).
Conclusion |
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.
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Vol 13 - N° 1
P. 56 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.