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Abstract

Background

Global left ventricular myocardial work indices (GLVMWI) are derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) are derived from these measures. GLVMWI in ST-segment elevation myocardial infarction (STEMI) remains unexplored and comparison between measures of GLVMWI at index event (baseline) and follow-up is unknown.

Purpose

To assess the evolution in GLVMWI in STEMI patients from baseline (index infarct) to 3 months' follow-up.

Methods

This retrospective study included 350 patients (265 men, mean age: 61±10 years) with STEMI treated with primary percutaneous coronary intervention and optimal, guideline-based medical therapy. Clinical variables, echocardiographic measures and GLVMWI were recorded at baseline and 3 months follow-up.

Results

Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GWI, GCW and GWE improved significantly at 3 months follow-up with no significant difference in GWW (Table). These findings suggest that the impaired values of GLVMWI at baseline are related to stunning after STEMI and they recover at 3 months follow-up without further deterioration in GWW, which probably reflects irreversible myocardial damage.

Conclusions

In STEMI patients treated with primary percutaneous coronary intervention and optimal guideline-based medical therapy, GLVMWI assessed by speckle tracking strain echocardiography are significantly improved at 3 months follow-up, without significant changes in GWW. GLVMWI therefore have the potential to identify reversible and irreversible components of post-infarct myocardial damage.

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Table 1. Baseline and follow-up GLVMWI

Baseline (n=350)Follow-up (n=350)P-value
LVEF (%)54±1057±10<0.001
LVESV (ml)39 [29–51]36 [26–51]0.032
LVEDV (ml)84 [68–105]87 [69–110]0.006
GLS (%)−15±4−17±4<0.001
GWI (mmHg%)1449±4511953±492<0.001
GCW (mmHg%)1624±5192228±563<0.001
GWW (mmHg%)101 [63–155]96 [64–155]0.535
GWE (%)93 [86–95]95 [91–96]<0.001
Baseline (n=350)Follow-up (n=350)P-value
LVEF (%)54±1057±10<0.001
LVESV (ml)39 [29–51]36 [26–51]0.032
LVEDV (ml)84 [68–105]87 [69–110]0.006
GLS (%)−15±4−17±4<0.001
GWI (mmHg%)1449±4511953±492<0.001
GCW (mmHg%)1624±5192228±563<0.001
GWW (mmHg%)101 [63–155]96 [64–155]0.535
GWE (%)93 [86–95]95 [91–96]<0.001

LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): European Society of Cardiology Research Grant

Tissue Doppler, Speckle Tracking and Strain Imaging
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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://dbpia.nl.go.kr/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
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