Coisne Augustin, Fourdinier Victor, Lemesle Gilles, Delsart Pascal, Aghezzaf Samy, Lamblin Nicolas, Schurtz Guillaume, Verdier Basile, Ninni Sandro, Delobelle Antoine, Favata Francesco, Garret Camille, Seunes Claire, Coppin Amandine, Donal Erwan, Scotti Andrea, Latib Azeem, Granada Juan F, Bauters Christophe, Montaigne David
Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France.
Heart and Lung Institute, University Hospital of Lille, F-59000 Lille, France.
Eur Heart J Open. 2022 May 20;2(3):oeac037. doi: 10.1093/ehjopen/oeac037. eCollection 2022 May.
To investigate the additional prognostic value of myocardial work (MW) parameters following acute myocardial infarction (AMI).
Between 2018 and 2020, 244 patients admitted in the cardiac intensive care unit in Lille University Hospital for AMI were included. One-month following AMI, 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 revascularization. At 1-month, half of the population was symptomatic (NYHA ≥ II), and medical therapy was almost optimized (angiotensin-converting enzyme inhibitor/angiotensin 2 receptor blocker in 95.5%, beta-blockers in 96.3%, DAPT in 94.7%, and statins in 97.1%). After a median follow-up of 681 (interquartile range: 538-840) days, ME occurred in 26 patients (10.7%). Patients presenting ME were older (65.5 ± 14.2 vs. 58.1 ± 12.1years, = 0.005) with a higher prevalence of hypertension (65.4 vs. 36.2%, = 0.004), more impaired left ventricular (LV) function as assessed by LV ejection fraction ( = 0.07), global longitudinal strain ( = 0.03), or MW parameters [ = 0.01 for global work efficiency (GWE)], and greater LV and left atrium dilatations ( = 0.06 for left ventricular end-diastolic volume index and = 0.03 for left atrial volume index). After adjustment, GWE was the only TTE parameter independently associated with long-term occurrence of ME ( = 0.02). A GWE value <91% was selected to identify patients at higher ME risk (hazard ratio: 95% confidence interval) = 2.94 (1.36-6.35), = 0.0041).
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.
研究急性心肌梗死（AMI）后心肌做功（MW）参数的额外预后价值。
纳入2018年至2020年间在里尔大学医院心脏重症监护病房因AMI入院的244例患者。AMI后1个月，进行全面经胸超声心动图（TTE）检查以评估心肌功能参数。随后对患者进行主要事件（ME）随访：心血管死亡、心力衰竭和非计划性冠状动脉血运重建。在1个月时，一半患者有症状（纽约心脏协会分级≥Ⅱ级），药物治疗几乎达到最佳状态（95.5%使用血管紧张素转换酶抑制剂/血管紧张素2受体阻滞剂，96.3%使用β受体阻滞剂，94.7%使用双联抗血小板治疗，97.1%使用他汀类药物）。中位随访681（四分位间距：538 - 840）天后，26例患者（10.7%）发生ME。发生ME的患者年龄更大（65.5±14.2岁对58.1±12.1岁，P = 0.005），高血压患病率更高（分别为65.4%对36.2%，P = 0.004），左心室（LV）功能受损更严重，通过左心室射血分数（P = 0.07）、整体纵向应变（P = 0.03）或MW参数[整体做功效率（GWE）P = 0.01]评估，且左心室和左心房扩张更明显（左心室舒张末期容积指数P = 0.06，左心房容积指数P = 0.03）。调整后，GWE是唯一与ME长期发生独立相关的TTE参数（P = 0.02）。选择GWE值<91%来识别ME风险较高的患者（风险比：95%置信区间）= 2.94（1.36 - 6.35），P = 0.0041）。
AMI后1个月时较低的GWE与较高的ME发生率独立相关。GWE<91%可改善AMI后患者的风险分层。
