Available online 22 May 2023

Predicting left ventricular recovery (LVR) after acute ST-segment elevation myocardial infarction (STEMI) is of prognostic importance. This study aims to explore the prognostic implications of segmental noninvasive myocardial work (MW) and microvascular perfusion (MVP) after STEMI.

In this retrospective study, 112 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) and transthoracic echocardiography after PCI were enrolled. MVP was analyzed by myocardial contrast echocardiography (MCE), and segmental MW was analyzed by noninvasive pressure-strain loops. 671 segments with abnormal function at baseline were analyzed. The degrees of MVP were observed following intermittent high-mechanical index impluses: replenishment within 4 sec (normal MVP, nMVP), replenishment >4 sec and within 10 sec (delayed MVP, dMVP), persistent defect (microvascular obstruction, MVO). The correlation between MW and MVP was analyzed. The correlation of the MW and MVP with LVR (normalization of wall thickening, >25%) was assessed. The prognostic value of segmental MW and MVP for cardiac events (cardiac death, admission for congestive heart failure or recurrent myocardial infarction) were evaluated.

NMVP was seen in 70 segments, dMVP in 236, and MVO in 365. The sMW indices were independently correlated with MVP. 244 (36.4%) segments had segmental LVR at 3 month follow-up. Segmental myocardial work efficiency (sMWE) and MVP were independently associated with segmental LVR (P<0.05). The χ2 of combination of sMWE and MVP was higher than either index alone for identifying segmental LVR (P<0.001). At a median follow-up of 42.0 months, cardiac events occurred in 13 patients; all regional MW parameters, high sensitivity troponin I (hs-TNI), regional longitudinal strain (rLS), et al were associated with cardiac events.

SMW indices are associated with MVP within the infarct zone following reperfused STEMI. Both were independently associated with segmental LVR , and regional MW was associated with cardiac events , providing prognostic value in STEMI patients.

2023 Published by Elsevier Inc. on behalf of the American Society of Echocardiography.