Lustosa Rodolfo P, Butcher Steele C, van der Bijl Pieter, El Mahdiui Mohammed, Montero-Cabezas Jose M, Kostyukevich Marina V, Rocha De Lorenzo Andrea, Knuuti Juhani, Ajmone Marsan Nina, Bax Jeroen J, Delgado Victoria
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands (R.P.L., S.C.B., P.v.d.B., M.E.M., J.M.M.-C., M.V.K., J.K., N.A.M., J.J.B., V.D.).
National Institute of Cardiology, Rio de Janeiro, Brazil (R.P.L., A.R.D.L.).
Circ Cardiovasc Imaging. 2021 Mar;14(3):e012072. doi: 10.1161/CIRCIMAGING.120.012072. Epub 2021 Mar 2.
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.
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.
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 <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]; <0.001).
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.
在ST段抬高型心肌梗死患者中，左心室（LV）整体纵向应变已显示出比左心室射血分数更高的预后价值。然而，左心室整体纵向应变未考虑后负荷的影响。新型心肌工作斑点追踪超声心动图指标将血压测量值（后负荷）与左心室整体纵向应变相结合。本研究旨在探讨通过超声心动图压力应变环获得的左心室整体心肌工作效率（GLVMWE；反映左心室功能）在ST段抬高型心肌梗死患者中的预后价值。
对507例ST段抬高型心肌梗死患者（平均年龄61±11岁；76%为男性）进行回顾性分析。入院后48小时内通过经胸超声心动图测量左心室射血分数和GLVMWE。GLVMWE定义为所有左心室节段建设性功除以建设性功与浪费功之和的比值，并以百分比表示。采用样条曲线分析来确定GLVMWE降低与全因死亡之间的关联。
中位随访80个月（四分位间距67 - 97个月）后，40例（8%）患者死亡。与GLVMWE保留（≥86%）的患者相比，GLVMWE降低（<86%）的患者全因死亡率累积发生率更高（17.5%对4.7%；对数秩检验<0.001）。GLVMWE降低（<86%）与全因死亡率独立相关（风险比3.167 [95%置信区间1.679 - 5.972]；<0.001）。
ST段抬高型心肌梗死患者入院后48小时内通过经胸超声心动图测量的GLVMWE降低（<86%）与较差的长期生存率相关。
