Clinical significance of myocardial work parameters after acute myocardial infarction. (3rd October 2022)

• Record Type: Journal Article
• 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
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.015
• Languages: English
• ISSNs: 0195-668X

Abstract

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.