Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment–Elevation Myocardial Infarction

心脏病学 内科学 医学 心肌梗塞 射血分数 后负荷 斑点追踪超声心动图 四分位间距 危险系数 心力衰竭 心室 置信区间
作者
Rodolfo de Paula Lustosa,Steele C. Butcher,Pieter van der Bijl,Mohammed El Mahdiui,José M. Montero-Cabezas,Marina V. Kostyukevich,Andréa Rocha de Lorenzo,Juhani Knuuti,Nina Ajmone Marsan,Jeroen J. Bax,Victoria Delgado
出处
期刊:Circulation-cardiovascular Imaging [Lippincott Williams & Wilkins]
卷期号:14 (3) 被引量:36
标识
DOI:10.1161/circimaging.120.012072
摘要

Background: Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction in patients with ST-segment–elevation myocardial infarction. However, LV global longitudinal strain does not take into consideration the effect of afterload. Novel speckle-tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV global longitudinal strain. The present study aimed to investigate the prognostic value of global LV myocardial work efficiency (GLVMWE; reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with ST-segment–elevation myocardial infarction. Methods: A total of 507 ST-segment–elevation myocardial infarction patients (mean age, 61±11 years; 76% men) were retrospectively analyzed. LV ejection fraction and GLVMWE were measured by transthoracic echocardiography within 48 hours of admission. GLVMWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments and expressed as a percentage. Spline curve analysis was used to define the association between reduced GLVMWE and all-cause death. Results: After a median follow-up of 80 months (interquartile range, 67–97 months), 40 (8%) patients died. Patients with reduced GLVMWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% versus 4.7%; log-rank P <0.001) in comparison with patients with preserved GLVMWE (≥86%). Reduced GLVMWE (<86%) showed an independent association with all-cause mortality (hazard ratio, 3.167 [95% CI, 1.679–5.972]; P <0.001). Conclusions: Reduced GLVMWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in ST-segment–elevation myocardial infarction patients is associated with worse long-term survival.
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