Predictive possibilities of parameters of myocardial work of left ventricle in patients with first myocardial infarction and percutaneous coronary intervention

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. 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. 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. 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. 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.

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