Clinical significance of myocardial work parameters after acute myocardial infarction

To date, there is little data regarding the clinical significance of myocardial work (MW) parameters after a stable period following acute myocardial infarction (AMI).

To investigate the additional prognostic value of MW parameters following AMI.

Between 2018 and 2020, 244 patients admitted in cardiac intensive care unit of a university hospital for AMI were included. One-month following AMI, a 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 revascularisation.

At 1 month, half of the population was symptomatic (NYHA≥II), and medical therapy was almost optimized (ACEi/ARB in 95.5%, beta-blockers in 96.3%, DAPT in 94.7% and statins in 97.1%). After a median follow-up of 681 [IQR 538–840] days, ME occurred in 26 patients (10.7%). Patients presenting ME were older (65.5±14.2 vs. 58.1±12.1 years, P=0.005) with higher prevalence of hypertension (65.4 vs. 36.2%, P=0.004), more impaired LV function as assessed by left ventricular ejection fraction (LVEF) (P=0.07), global longitudinal strain (GLS) (P=0.03) or MW parameters (P=0.01 for global work efficiency (GWE)), and greater LV and LA dilations (P=0.06 for LVEDVi and P=0.03 for LAVi). After adjustment, GWE was the only TTE parameter independently associated with long-term occurrence of ME (P=0.02). A GWE value <91% was selected to identify patients at higher ME risk (HR 95% CI) = 2.94 (1.36–6.35), P=0.0041) (Figure 1 & 2).

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.

Type of funding sources: None.