Journal of the American Society of Echocardiography
Focus Topic: Myocardial WorkClinical InvestigationsAssociation Between Segmental Noninvasive Myocardial Work and Microvascular Perfusion in ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Functional Recovery and Clinical Outcomes
Section snippets
Patient Population
A total of 138 patients admitted with an initial diagnosis of STEMI who underwent successful primary PCI at the First Affiliated Hospital of Dalian Medical University from September 2017 to December 2021 were included in this retrospective evaluation; furthermore, all culprit arteries achieved thrombolysis in myocardial infarction (TIMI) 3 flow. Within 72 hours after PCI, two-dimensional (2D) echocardiography and MCE were performed. Patients with known moderate or severe valvular heart disease,
Clinical and Echocardiography Characteristics
A total of 138 patients with STEMI who underwent primary PCI were reviewed. Twenty-six patients were excluded because of moderate or severe valvular heart disease (n = 6), primary cardiomyopathy (n = 2), congenital heart disease (n = 1), previous cardiac surgery (n = 1), previous myocardial infarction (n = 2), or poor-quality images (n = 14), which was defined as not analyzable by LS or MW (≥2 consecutive segments indistinct for MW analysis). Thus, 112 patients were included in the study. The
Discussion
This study indicated that in the contemporary era of primary successful PCI treatment of STEMI with TIMI 3 flow in the culprit vessel, segmental MVP and MW abnormalities were frequently found within 72 hours after PCI. Segments with MVO showed more impaired MW indices compared with those with normal MVP and dMVP segments. In addition, sMWI, sMWE, sMCW, and sLS were independently associated with MVP. Segments that did not recover at 3-month follow-up showed more impaired MW indices compared with
Conclusion
Segmental noninvasive MW is correlated with segmental MVP within the infarct zone following reperfused STEMI. Myocardial work efficiency and MVP are independently associated with segmental LVR. We demonstrated that all regional MW parameters are associated with cardiac events at follow-up. These noninvasive echocardiography parameters may improve the evaluation of myocardial viability and prognosis in patients with STEMI who undergo primary PCI.
Acknowledgments
We thank all those who helped us during the writing of this manuscript and members of the Department of Cardiac Ultrasound for their acquisition of data.
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Conflicts of Interest: None.
This work was supported by the Liaoning Provincial Natural Science Foundation (grant no. 2019-ZD-0629).