Clinical significance of myocardial work parameters after acute myocardial infarction

• Published in: European heart journal Vol. 43; no. Supplement_2
• Main Authors: Coisne, A, Fourdinier, V, Lemesle, G, Delsart, P, Aghezzaf, S, Lamblin, N, Schurtz, G, Verdier, B, Ninni, S, Seunes, C, Coppin, A, Donal, E, Scotti, A, Bauters, C, Montaigne, D
• Format: Journal Article
• Language: English
• Published: 03.10.2022
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehac544.015

Abstract Background To date, there is little data regarding the clinical significance of myocardial work (MW) parameters after a stable period following acute myocardial infarction (AMI). Purpose To investigate the additional prognostic value of MW parameters following AMI. Methods Between 2018 and 2020, 244 patients admitted in cardiac intensive care unit of a university hospital for AMI were included. One-month following AMI, a comprehensive transthoracic echocardiography (TTE) was performed to assess parameters of myocardial function. Patients were then followed for major events (ME): cardiovascular death, heart failure and unplanned coronary revascularisation. Results At 1 month, half of the population was symptomatic (NYHA≥II), and medical therapy was almost optimized (ACEi/ARB in 95.5%, beta-blockers in 96.3%, DAPT in 94.7% and statins in 97.1%). After a median follow-up of 681 [IQR 538–840] days, ME occurred in 26 patients (10.7%). Patients presenting ME were older (65.5±14.2 vs. 58.1±12.1 years, P=0.005) with higher prevalence of hypertension (65.4 vs. 36.2%, P=0.004), more impaired LV function as assessed by left ventricular ejection fraction (LVEF) (P=0.07), global longitudinal strain (GLS) (P=0.03) or MW parameters (P=0.01 for global work efficiency (GWE)), and greater LV and LA dilations (P=0.06 for LVEDVi and P=0.03 for LAVi). After adjustment, GWE was the only TTE parameter independently associated with long-term occurrence of ME (P=0.02). A GWE value <91% was selected to identify patients at higher ME risk (HR 95% CI) = 2.94 (1.36–6.35), P=0.0041) (Figure 1 & 2). Conclusion Lower GWE at 1 month after AMI is independently associated with higher ME rates. A GWE <91% can improve the post-AMI patient risk stratification. Funding Acknowledgement Type of funding sources: None.