Inhomogeneous Distribution of Regional Myocardial Work Efficiency Predicts Early Left Ventricular Remodeling After Acute Anterior Myocardial Infarction Treated With Primary Percutaneous Intervention

Abstract

Background: This study aimed to investigate the hypothesis that specific pattern of myocardial work (MW) distribution in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) could provide prognostic value for predicting left ventricular (LV) remodeling.

Methods: A total of 98 first anterior wall STEMI patients treated with primary percutaneous coronary intervention [85 men (86.7%), mean age: 58 ± 12 years] were enrolled. Transthoracic echocardiography was performed 24-72 h after angioplasty and during 3-month follow-up. MW was estimated from the left ventricular pressure-strain loop derived from speckle tracking echocardiography and simultaneous noninvasive brachial artery cuff pressure. The primary endpoint was early LV remodeling, defined as an increase in LV end-diastolic volume ≥20% compared with baseline at 3 months after STEMI. Major adverse cardiac events and combined clinical outcomes were recorded.

Results: LV remodeling was present in 32 patients (33%), who exhibited lower global and culprit-regional work index (WI), constructive work (CW), work efficiency (WE), and specifically, greater differences of WE (delta-WE) and CW (delta-CW) between the culprit and non-culprit region than those without LV remodeling both at the acute phase and follow-up (all P < 0.0125). During follow-up, all global and regional WI, CW, and WE were improved (P < 0.0125 compared with baseline), with less improvement in patients with LV remodeling. In multivariate analysis, baseline delta-WE (odds ratio: 2.304; 95% CI: 1.093-4.856, P = 0.028) and peak troponin I level (odds ratio: 1.035; 95%CI: 1.008-1.063, P = 0.010) were independently associated with early LV remodeling. Patients with greater delta-WE at baseline were associated with a higher incidence of heart failure and combined clinical outcomes during follow-up.

Conclusion: After reperfused acute anterior STEMI, patients with LV remodeling presented with more inhomogeneous MW distribution. The absolute difference of WE between culprit and non-culprit territory at the acute phase is an independent predictor for early LV remodeling.

Clinical trial registration: www.ClinicalTrials.gov, identifier: NCT05107102.

Keywords: ST-segment elevation myocardial infarction; echocardiography; left ventricular remodeling; myocardial work; work efficiency.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wang, Zhao, Wan, Shen, Ding and Pu.

Figures

Figure 1

The18-segment model for myocardial work analysis. Red dots indicate the segments of the left anterior descending coronary artery (LAD) territory, while yellow dots indicate the non-LAD territory.

Figure 2

Flowchart for the selection of our study population.

Figure 3

Representative WE bull's-eye plots of patients without (A) and with (B) early left ventricular remodeling. Asterisks indicate segments assigned to the left anterior descending coronary artery (LAD) territory. The no-remodeling patient showed relatively homogeneous regional WE (presented in green) between LAD and non-LAD territory. In contrast, the remodeling patient exhibited significantly reduced WE in LAD territory (presented in yellow and orange). The index of delta-WE (calculated as WENONLAD – WELAD) was much greater in the remodeling patient than the no-remodeling (28 vs. 11%), indicating a more inhomogeneous distribution of regional WE. LAD, left anterior descending artery coronary artery; LV, left ventricular; WE, work efficiency; WELAD, average of segmental WE in LAD territory; WENONLAD, average of segmental WE in non-LAD territory.

Figure 4

Receiver operating characteristic curves of delta-WE to identify early LV remodeling in anterior STEMI patients.

Figure 5

Comparisons of receiver operating characteristic curves of baseline traditional clinical risk factors with and without delta-WE to predict early left ventricular remodeling in anterior STEMI patients. AUC, area under the curve.