medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»medalphabet-3098Research ArticleСтатьиПредикторные возможности параметров миокардиальной работы левого желудочка у пациентов с первым инфарктом миокарда и чрескожным коронарным вмешательствомPredictive possibilities of parameters of myocardial work of left ventricle in patients with first myocardial infarction and percutaneous coronary interventionhttps://orcid.org/0000-0001-6586-7404ТимофееваТ. М.TimofeevaT. M.

Тимофеева Татьяна Михайловна, врач функциональной диагностики, ассистент кафедры

Москва

Timofeeva Tatyana M., doctor of functional diagnostics, assistant

Moscow

timtan@bk.ruhttps://orcid.org/0000-0003-2412-5986СафароваА. Ф.SafarovaA. F.

Сафарова Айтен Фуад Кызы, д.м.н., врач функциональной диагностики, проф. кафедры

Москва

Safarova Ayten F.K., DM Sci (habil.), doctor of functional diagnostics, professor

Moscow

aytensaf@mail.ruhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна, д.м.н., проф., член-корр. РАН, зав. кафедрой

Москва

Kobalava Zhanna D., DM Sci (habil.), professor, head of Dept

Moscow

zkobalava@mail.ruhttps://orcid.org/0000-0002-4389-9752ЕфимоваВ. П.EfimovaV. P.

Ефимова Виктория Павловна, к.м.н., зав. отделением ультразвуковых и функциональных методов диагностики

Москва

Efimova Victoria P., PhD Med, head of Dept of Ultrasound and Functional Diagnostic Methods

Moscow

https://orcid.org/0000-0002-3461-9632ЛобжанидзеТ. В.LobzhanidzeT. V.

Лобжанидзе Тина Викторовна, к.м.н., доцент

Москва

Lobzhanidze Tina V., PhD Med, associate professor

Moscow

https://orcid.org/0000-0002-9538-921XОзоваЕ. М.OzovaE. M.

Озова Елена Меджидовна, к.м.н., врач функциональной диагностики, ассистент

Москва

Ozova Elena M., PhD Med, doctor of functional diagnostics, assistant

Moscow

ГБУЗ «Городская клиническая больница имени В.В. Виноградова Департамента здравоохранения Москвы»; Кафедра внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В.С. Моисеева медицинского института ФГАОУ ВО «Российский университет дружбы народов»РоссияCity Clinical Hospital n.a. V.V. Vinogradov; Peoples’ Friendship University of RussiaRussian FederationКафедра внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В.С. Моисеева медицинского института ФГАОУ ВО «Российский университет дружбы народов»РоссияPeoples’ Friendship University of RussiaRussian FederationГБУЗ «Городская клиническая больница имени В.В. Виноградова Департамента здравоохранения Москвы»РоссияCity Clinical Hospital n.a. V.V. VinogradovRussian FederationГБУЗ «Городская клиническая больница имени В.В. Виноградова Департамента здравоохранения Москвы»; Кафедра внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В.С. Моисеева медицинского института ФГАОУ ВО «Российский университет дружбы народов»РоссияPeoples’ Friendship University of RussiaRussian Federation20230706202306Кардиология. Неотложная медицина» (1)714Copyright © Тимофеева Т.М., Сафарова А.Ф., Кобалава Ж.Д., Ефимова В.П., Лобжанидзе Т.В., Озова Е.М., 20232023Тимофеева Т.М., Сафарова А.Ф., Кобалава Ж.Д., Ефимова В.П., Лобжанидзе Т.В., Озова Е.М.Timofeeva T.M., Safarova A.F., Kobalava Z.D., Efimova V.P., Lobzhanidze T.V., Ozova E.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3098Введение

Введение. Оценка миокардиальной работы (МР) демонстрирует неоспоримые преимущества по сравнению с фракцией выброса левого желудочка (ФВ ЛЖ) для оценки прогноза после инфаркта миокарда (ИМ), поскольку учитывает уровень постнагрузки. Роль миокардиальных индексов в прогнозировании исходов у пациентов после первого острого ИМ изучена недостаточно.

Цель исследования

Цель исследования. Оценка параметров глобальной продольной деформации (GLS) ЛЖ, МР и их прогностической способности у пациентов с первым ИМ и успешным чрескожным коронарным вмешательством (ЧКВ).

Методы

Методы. В проспективное одноцентровое исследование включен 131 пациент с первым острым ИМ без анамнеза сердечной недостаточности (СН) и успешным ЧКВ. ФВ ЛЖ оценивалась перед ЧКВ и повторно перед выпиской из стационара с параметрами МР и GLS. Конечная точка: госпитализация c СН. Медиана периода наблюдения: 1,5 года.

Результаты

Результаты. ИМ с подъемом сегмента ST диагностирован у 26,0% пациентов; ФВ ЛЖ менее 50% при выписке регистрировалась у 64 (48,9%) пациентов. Средний перипроцедурный прирост ФВ ЛЖ составил 4,0% в общей группе. Госпитализация с СН за период наблюдения зарегистрирована у 34 (26,0%) пациентов. Предикторами ее явились значения глобальной напрасной работы (GWW) > 161,5 mmHg% и GLS < 13,7% (р = 0,026, AUC = 0,638 и р = 0,024, AUC = 0,628 соответственно). GWW < 161,5 mmHg% уменьшает риски госпитализации с СН в 2,65 раза (ОР = 0,377; 95% ДИ: 0,158–0,900; p = 0,028). Бессобытийная выживаемость у пациентов со значениями GWW больше и меньше порогового уровня максимально различается через 2 года и более после ОИМ. При уровне GLS > 13,7% перед выпиской риск госпитализации с СН в течение 1,5 года снижается в 2,34 раза (ОШ = 0,428; 95% ДИ: 0,182–0,960). Значимыми предикторами госпитализации с СН являются GLS (ОШ = 0,75; 95% ДИ: 0,61–0,92; р = 0,006), GCW (ОШ = 0,85; 95% ДИ: 0,74–0,99; р = 0,036) и ΔФВ ЛЖ (ОШ = 0,88; 95% ДИ: 0,78–0,99; р = 0,040), вошедшие в разработанную прогностическую модель.

Заключение

Заключение. У пациентов с первым острым ИМ, независимо от ФВ ЛЖ при поступлении, при отсутствии клинических признаков СН для расчета риска госпитализации с СН в течение 550 дней может использоваться разработанная прогностическая модель, включающая показатели GLS, GCW и ΔФВ ЛЖ, а также учитываться уровень GWW.

Introduction

Introduction. The assessment of myocardial work (MW) demonstrates undeniable advantages over the left ventricular ejection fraction (LVEF) for assessing the prognosis after myocardial infarction (MI), since it takes into account the level of afterload. The role of myocardial indices in predicting outcomes in patients after the first acute MI is not well understood.

Purpose of the study

Purpose of the study. Evaluation of parameters of global longitudinal strain (GLS), MW and their predictive ability in patients with first MI and successful percutaneous coronary intervention (PCI).

Methods

Methods. A prospective single-center study included 131 patients with a first acute MWZ without a history of heart failure (HF) and successful PCI. LV EF was assessed before PCI and again before discharge from the hospital with MW and GLS parameters. Endpoint: hospitalization with HF. Median follow-up: 1.5 years.

Results

Results. ST elevation MWZ was diagnosed in 26.0% of patients; LV EF less than 50% at discharge was recorded in 64 patients (48.9%). The average periprocedural increase in LV EF was 4% in the general group. Hospitalization with HF during the observation period was registered in 34 (26.0%) patients. It was predicted by global wasted work (GWW) > 161.5 mmHg% and GLS < 13.7% (p = 0.026, AUC = 0.638 and p = 0.024, AUC = 0.628 respectively). GWW < 161.5 mmHg% reduces the risk of hospitalization with HF by 2.65 times (HR = 0.377 with 95% CI: 0.158–0.900; p = 0.028). Event-free survival in patients with GWW values above and below the threshold level differs to the maximum 2 or more years after AMI. At GLS > 13.7% before discharge, the risk of hospitalization with HF within 1.5 years is reduced by 2.34 times (OR = 0.428; 95% CI: 0.182–0.960). Significant predictors of hospitalization with HF are GLS (OR = 0.75; 95% CI: 0.61–0.92; p = 0.006), GCW (OR = 0.85; 95% CI: 0.74–0.99; p = 0.036) and LVEF (OR = 0.88; 95% CI: 0.78–0.99; p = 0.040) included in the developed prognostic model.

Conclusion

Conclusion. In patients with first acute MI, regardless of LV EF, at admission in the absence of clinical signs of HF, a developed prognostic model can be used to calculate the risk of hospitalization with HF within 550 days, including GLS, GCW and LV ΔEF, and the GWW level can also be taken into account.

инфаркт миокардаспекл-трекинг эхокардиографиямиокардиальная работаmyocardial infarctionspeckle tracking echocardiographymyocardial workReferencesIbanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients pre- senting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119–177. DOI: 10.1093/eurheartj/ehx393.Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients pre- senting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39: 119–177. DOI: 10.1093/eurheartj/ehx393.Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J 2016; 37: 3232–45.Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur Heart J 2016; 37: 3232–45.van der Bijl P, Abou R, Goedemans L, Gersh BJ, Holmes DR Jr, Ajmone Marsan N, Delgado V, Bax JJ. Left ventricular post-infarct remodeling: Implications for systolic function improvement and outcomes in the modern era. JACC Heart Fail. 2020; 8: 131–140. DOI: 10.1016/j.jchf.2019.08.014.van der Bijl P, Abou R, Goedemans L, Gersh BJ, Holmes DR Jr, Ajmone Marsan N, Delgado V, Bax JJ. Left ventricular post-infarct remodeling: Implications for systolic function improvement and outcomes in the modern era. JACC Heart Fail. 2020; 8: 131–140. DOI: 10.1016/j.jchf.2019.08.014.Stone GW, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Maehara A, Eitel I, Granger CB, Jenkins PL, et al. Relationship between infarct size and outcomes following primary PCI: Patient-level analysis from 10 randomized trials. J Am Coll Cardiol. 2016; 67: 1674–83. DOI: 10.1016/j.jacc.2016.01.069.Stone GW, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Maehara A, Eitel I, Granger CB, Jenkins PL, et al. Relationship between infarct size and outcomes following primary PCI: Patient-level analysis from 10 randomized trials. J Am Coll Cardiol. 2016; 67: 1674–83. DOI: 10.1016/j.jacc.2016.01.069.Hall TS, von Lueder TG, Zannad F, Rossignol P, Duarte K, Chouihed T, Dickstein K, Atar D, Agewall S, Girerd N; High-Risk Myocardial Infarction Database Initiative Investigators. Relationship between left ventricular ejection fraction and mortality after myocardial infarction complicated by heart failure or left ventricular dysfunction. Int J Cardiol. 2018; 272: 260–266. DOI: 10.1016/j.ijcard.2018.07.137.Hall TS, von Lueder TG, Zannad F, Rossignol P, Duarte K, Chouihed T, Dickstein K, Atar D, Agewall S, Girerd N; High-Risk Myocardial Infarction Database Initiative Investigators. Relationship between left ventricular ejection fraction and mortality after myocardial infarction complicated by heart failure or left ventricular dysfunction. Int J Cardiol. 2018; 272: 260–266. DOI: 10.1016/j.ijcard.2018.07.137.Marwick TH. Ejection fraction pros and cons: JACC state-of-the-art review. J Am Coll Cardiol. 2018; 72: 2360–2379. DOI: 10.1016/j.jacc.2018.08.2162.Marwick TH. Ejection fraction pros and cons: JACC state-of-the-art review. J Am Coll Cardiol. 2018; 72: 2360–2379. DOI: 10.1016/j.jacc.2018.08.2162.Munk K, Andersen NH, Terkelsen CJ, Bibby BM, Johnsen SP, Bøtker HE, Nielsen TT, Poulsen SH. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr. 2012; 25: 644–651. DOI: 10.1016/j.echo.2012.02.003.Munk K, Andersen NH, Terkelsen CJ, Bibby BM, Johnsen SP, Bøtker HE, Nielsen TT, Poulsen SH. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr. 2012; 25: 644–651. DOI: 10.1016/j.echo.2012.02.003.Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010; 31: 1640–7. DOI: 10.1093/eurheartj/ehq105.Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010; 31: 1640–7. DOI: 10.1093/eurheartj/ehq105.Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to.2015. J Am Coll Cardiol 2017; 70: 1–25.Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to.2015. J Am Coll Cardiol 2017; 70: 1–25.Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J 2012; 33: 724–33.Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J 2012; 33: 724–33.Abou R, Leung M, Goedemans L, Hoogslag GE, Schalij MJ, Marsan NA et al. Effect of guideline-based therapy on left ventricular systolic function recovery. after ST-segment elevation myocardial infarction. Am J Cardiol 2018; 122: 1591–7.Abou R, Leung M, Goedemans L, Hoogslag GE, Schalij MJ, Marsan NA et al. Effect of guideline-based therapy on left ventricular systolic function recovery. after ST-segment elevation myocardial infarction. Am J Cardiol 2018; 122: 1591–7.Wu WY, Biery DW, Singh A, Divakaran S, Berman AN, Ayuba G, DeFilippis EM, Nasir K, Januzzi JL, Di Carli MF, Bhatt DL, Blankstein R. Recovery of Left Ventricular Systolic Function and Clinical Outcomes in Young Adults with Myocardial Infarction. J Am Coll Cardiol. 2020 Jun 9; 75 (22): 2804–2815. DOI: 10.1016/j.jacc.2020.03.074.Wu WY, Biery DW, Singh A, Divakaran S, Berman AN, Ayuba G, DeFilippis EM, Nasir K, Januzzi JL, Di Carli MF, Bhatt DL, Blankstein R. Recovery of Left Ventricular Systolic Function and Clinical Outcomes in Young Adults with Myocardial Infarction. J Am Coll Cardiol. 2020 Jun 9; 75 (22): 2804–2815. DOI: 10.1016/j.jacc.2020.03.074.Chew DS, Heikki H, Schmidt G, Kavanagh KM, Dommasch M, Bloch Thomsen PE et al. Change in left ventricular ejection fraction following first myocardial in- farction and outcome. JACC Clin Electrophysiol 2018; 4: 672–82.Chew DS, Heikki H, Schmidt G, Kavanagh KM, Dommasch M, Bloch Thomsen PE et al. Change in left ventricular ejection fraction following first myocardial in- farction and outcome. JACC Clin Electrophysiol 2018; 4: 672–82.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016 Apr; 29 (4): 277–314. DOI: 10.1016/j.echo.2016.01.011.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016 Apr; 29 (4): 277–314. DOI: 10.1016/j.echo.2016.01.011.Roemer S, Jaglan A, Santos D, Umland M, Jain R, Tajik AJ, Khandheria BK. The Utility of Myocardial Work in Clinical Practice. J Am Soc Echocardiogr. 2021 Aug; 34 (8): 807–818. Epub 2021 Apr 22. PMID: 33895250. DOI: 10.1016/j.echo.2021.04.013.Roemer S, Jaglan A, Santos D, Umland M, Jain R, Tajik AJ, Khandheria BK. The Utility of Myocardial Work in Clinical Practice. J Am Soc Echocardiogr. 2021 Aug; 34 (8): 807–818. Epub 2021 Apr 22. PMID: 33895250. DOI: 10.1016/j.echo.2021.04.013.Minicucci MF, Farah E, Fusco DR, Cogni AL, Azevedo PS, Okoshi K, Zanati SG, Matsubara BB, Paiva SA, Zornoff LA. Infarct size as predictor of systolic functional recovery after myocardial infarction. Arq Bras Cardiol. 2014 Jun; 102 (6): 549–56. DOI: 10.5935/abc.20140051.Minicucci MF, Farah E, Fusco DR, Cogni AL, Azevedo PS, Okoshi K, Zanati SG, Matsubara BB, Paiva SA, Zornoff LA. Infarct size as predictor of systolic functional recovery after myocardial infarction. Arq Bras Cardiol. 2014 Jun; 102 (6): 549–56. DOI: 10.5935/abc.20140051.Colvin MM, Sutton NR. Left Ventricular Recovery in Young Patients with Myocardial Infarction: How Much Is Enough? J Am Coll Cardiol. 2020 Jun 9; 75 (22): 2816–2818. DOI: 10.1016/j.jacc.2020.04.020.Colvin MM, Sutton NR. Left Ventricular Recovery in Young Patients with Myocardial Infarction: How Much Is Enough? J Am Coll Cardiol. 2020 Jun 9; 75 (22): 2816–2818. DOI: 10.1016/j.jacc.2020.04.020.Chew DS, Wilton SB, Kavanagh K, Southern DA, Tan-Mesiatowsky LE, Exner DV; APPROACH Investigators. Left ventricular ejection fraction reassessment post-myocardial infarction: Current clinical practice and determinants of adverse remodeling. Am Heart J. 2018 Apr; 198: 91–96. DOI: 10.1016/j.ahj.2017.11.014.Chew DS, Wilton SB, Kavanagh K, Southern DA, Tan-Mesiatowsky LE, Exner DV; APPROACH Investigators. Left ventricular ejection fraction reassessment post-myocardial infarction: Current clinical practice and determinants of adverse remodeling. Am Heart J. 2018 Apr; 198: 91–96. DOI: 10.1016/j.ahj.2017.11.014.Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Hassager C, Søgaard P, Køber L. Relationship between left ventricular longitudinal de- formation and clinical heart failure during admission for acute myocardial infarction: a two-dimensional speckle-tracking study. J Am Soc Echocar- diogr. 2012; 25: 1280–1289. DOI: 10.1016/j.echo.2012.09.006.Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Hassager C, Søgaard P, Køber L. Relationship between left ventricular longitudinal de- formation and clinical heart failure during admission for acute myocardial infarction: a two-dimensional speckle-tracking study. J Am Soc Echocar- diogr. 2012; 25: 1280–1289. DOI: 10.1016/j.echo.2012.09.006.Gavara J, Rodriguez-Palomares JF, Valente F, Monmeneu JV, Lopez- Lereu MP, Bonanad C, Ferreira-Gonzalez I, Garcia Del Blanco B, Rodriguez- Garcia J, Mutuberria M, et al. Prognostic value of strain by tissue tracking cardiac magnetic resonance after ST-segment elevation myocardial infarction. JACC Cardiovasc Imaging. 2018; 11: 1448–1457. DOI: 10.1016/j. jcmg.2017.09.017.Gavara J, Rodriguez-Palomares JF, Valente F, Monmeneu JV, Lopez- Lereu MP, Bonanad C, Ferreira-Gonzalez I, Garcia Del Blanco B, Rodriguez- Garcia J, Mutuberria M, et al. Prognostic value of strain by tissue tracking cardiac magnetic resonance after ST-segment elevation myocardial infarction. JACC Cardiovasc Imaging. 2018; 11: 1448–1457. DOI: 10.1016/j. jcmg.2017.09.017.Boe E, Russell K, Eek C, Eriksen M, Remme EW, Smiseth OA, Skulstad H. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2015; 16: 1247–1255. DOI: 10.1093/ehjci/jev078.Boe E, Russell K, Eek C, Eriksen M, Remme EW, Smiseth OA, Skulstad H. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2015; 16: 1247–1255. DOI: 10.1093/ehjci/jev078.El Mahdiui M, van der Bijl P, Abou R, Ajmone Marsan N, Delgado V, Bax JJ. Global left ventricular myocardial work efficiency in healthy individuals and patients with cardiovascular disease. J Am Soc Echocardiogr. 2019; 32: 1120–1127. DOI: 10.1016/j.echo.2019.05.002.El Mahdiui M, van der Bijl P, Abou R, Ajmone Marsan N, Delgado V, Bax JJ. Global left ventricular myocardial work efficiency in healthy individuals and patients with cardiovascular disease. J Am Soc Echocardiogr. 2019; 32: 1120–1127. DOI: 10.1016/j.echo.2019.05.002.Lopaschuk GD, Ussher JR, Folmes CD, Jaswal JS, Stanley WC. Myocardial fatty acid metabolism in health and disease. Physiol Rev. 2010; 90: 207–258. DOI: 10.1152/physrev.00015.2009.Lopaschuk GD, Ussher JR, Folmes CD, Jaswal JS, Stanley WC. Myocardial fatty acid metabolism in health and disease. Physiol Rev. 2010; 90: 207–258. DOI: 10.1152/physrev.00015.2009.Sörensen J, Harms HJ, Aalen JM, Baron T, Smiseth OA, Flachskampf FA. Myocardial efficiency: a fundamental physiological concept on the verge of clinical impact. JACC Cardiovasc Imaging. 2020; 13: 1564–1576. DOI: 10.1016/j.jcmg.2019.08.030.Sörensen J, Harms HJ, Aalen JM, Baron T, Smiseth OA, Flachskampf FA. Myocardial efficiency: a fundamental physiological concept on the verge of clinical impact. JACC Cardiovasc Imaging. 2020; 13: 1564–1576. DOI: 10.1016/j.jcmg.2019.08.030.Butcher SC, Lustosa RP, Abou R, Marsan NA, Bax JJ, Delgado V. Prognostic implications of left ventricular myocardial work index in patients with ST-segment elevation myocardial infarction and reduced left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2022 Apr 18; 23 (5): 699–707. PMID: 33993227. DOI: 10.1093/ehjci/jeab096.Butcher SC, Lustosa RP, Abou R, Marsan NA, Bax JJ, Delgado V. Prognostic implications of left ventricular myocardial work index in patients with ST-segment elevation myocardial infarction and reduced left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2022 Apr 18; 23 (5): 699–707. PMID: 33993227. DOI: 10.1093/ehjci/jeab096.van der Bijl P, Vo NM, Kostyukevich MV, Mertens B, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of global, left ventricular myocardial work efficiency before cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2019; 20: 1388–1394. DOI: 10.1093/ehjci/jez095.van der Bijl P, Vo NM, Kostyukevich MV, Mertens B, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of global, left ventricular myocardial work efficiency before cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2019; 20: 1388–1394. DOI: 10.1093/ehjci/jez095.Lustosa RP, Butcher SC, van der Bijl P, El Mahdiui M, Montero-Cabezas JM, Kostyukevich MV, Rocha De Lorenzo A, Knuuti J, Ajmone Marsan N, Bax JJ, Delgado V. Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging. 2021 Mar; 14 (3): e012072. DOI: 10.1161/circimaging.120.012072.Lustosa RP, Butcher SC, van der Bijl P, El Mahdiui M, Montero-Cabezas JM, Kostyukevich MV, Rocha De Lorenzo A, Knuuti J, Ajmone Marsan N, Bax JJ, Delgado V. Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging. 2021 Mar; 14 (3): e012072. DOI: 10.1161/circimaging.120.012072.

The authors declare that there are no conflicts of interest present.