Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization

Abstract Background Left ventricular myocardial work (MW) assessed by echocardiography has recently been introduced as a new index of global and regional myocardial performance. The presence of microvascular obstruction after revascularization in ST-segment elevation myocardial infarction (STEMI) pa...

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Main Authors: Wenying Jin, Lan Wang, Tiangang Zhu, Yuliang Ma, Chao Yu, Feng Zhang
Format: Article
Language:English
Published: BMC 2022-05-01
Series:BMC Cardiovascular Disorders
Subjects:
Online Access:https://doi.org/10.1186/s12872-022-02648-z
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author Wenying Jin
Lan Wang
Tiangang Zhu
Yuliang Ma
Chao Yu
Feng Zhang
author_facet Wenying Jin
Lan Wang
Tiangang Zhu
Yuliang Ma
Chao Yu
Feng Zhang
author_sort Wenying Jin
collection DOAJ
description Abstract Background Left ventricular myocardial work (MW) assessed by echocardiography has recently been introduced as a new index of global and regional myocardial performance. The presence of microvascular obstruction after revascularization in ST-segment elevation myocardial infarction (STEMI) patients predicts poor clinical outcomes. This study aimed to explore the usefulness of MW in identifying impaired microvascular perfusion (MVP) in the patients with STEMI after revascularization. Methods One hundred and sixty STEMI patients who underwent myocardial contrast echocardiography (MCE) within 48 h after percutaneous coronary intervention (PCI) were included. Patients were divided into normal MVP and impaired MVP groups according to the myocardial perfusion score. The clinical data, coronary angiography results and echocardiographic data including Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were collected. Results Impaired MVP was found in 60% of patients. Compared with the normal MVP group, GWI (909.2 ± 287.6 mmHg% vs. 1191.2 ± 378.2 mmHg%), GCW (1198.3 ± 339.6 mmHg% vs. 1525.9 ± 420.5 mmHg%), GWE (82.7 ± 7.8% vs. 86.8 ± 5.6%) and GLS (− 11.0 ± 3.4% vs. − 14.4 ± 3.8%) were significantly reduced in the impaired MVP group. Whereas there was no statistically significant difference in left ventricular ejection fraction (LVEF) and GWW, multivariate logistic regression analysis showed that peak troponin I (OR 1.017, 95% CI 1.006–1.029; P = 0.004), final TIMI flow ≤ 2 (OR 16.366, 95% CI 1.998–134.06; P = 0.009), left ventricular end-diastolic volume index (LVEDVi) (OR 1.139 95% CI 1.048–1.239; P = 0.002), and GWI (OR 0.997 95% CI 0.994–1.000; P = 0.029) were independently associated with impaired MVP. GWI showed a good sensitivity (86.8%) but low specificity (53.7%) in identifying impaired MVP (AUC 0.712, 95% CI 0.620–0.804; P < 0.001). Combination with GWI can improve the diagnostic value of TNI or LVEVi for impaired MVP. Conclusion Impaired MVP is relatively common in STEMI patients after revascularization and independently associated with left ventricular GWI assessed by echocardiography. GWI confer incremental value to MVP assessment in STEMI patients.
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spelling doaj.art-3757e9b295ad476a8e052816d96145432022-12-22T00:39:55ZengBMCBMC Cardiovascular Disorders1471-22612022-05-012211910.1186/s12872-022-02648-zUsefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularizationWenying Jin0Lan Wang1Tiangang Zhu2Yuliang Ma3Chao Yu4Feng Zhang5Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalDepartment of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalDepartment of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalDepartment of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalDepartment of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalDepartment of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People’s HospitalAbstract Background Left ventricular myocardial work (MW) assessed by echocardiography has recently been introduced as a new index of global and regional myocardial performance. The presence of microvascular obstruction after revascularization in ST-segment elevation myocardial infarction (STEMI) patients predicts poor clinical outcomes. This study aimed to explore the usefulness of MW in identifying impaired microvascular perfusion (MVP) in the patients with STEMI after revascularization. Methods One hundred and sixty STEMI patients who underwent myocardial contrast echocardiography (MCE) within 48 h after percutaneous coronary intervention (PCI) were included. Patients were divided into normal MVP and impaired MVP groups according to the myocardial perfusion score. The clinical data, coronary angiography results and echocardiographic data including Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were collected. Results Impaired MVP was found in 60% of patients. Compared with the normal MVP group, GWI (909.2 ± 287.6 mmHg% vs. 1191.2 ± 378.2 mmHg%), GCW (1198.3 ± 339.6 mmHg% vs. 1525.9 ± 420.5 mmHg%), GWE (82.7 ± 7.8% vs. 86.8 ± 5.6%) and GLS (− 11.0 ± 3.4% vs. − 14.4 ± 3.8%) were significantly reduced in the impaired MVP group. Whereas there was no statistically significant difference in left ventricular ejection fraction (LVEF) and GWW, multivariate logistic regression analysis showed that peak troponin I (OR 1.017, 95% CI 1.006–1.029; P = 0.004), final TIMI flow ≤ 2 (OR 16.366, 95% CI 1.998–134.06; P = 0.009), left ventricular end-diastolic volume index (LVEDVi) (OR 1.139 95% CI 1.048–1.239; P = 0.002), and GWI (OR 0.997 95% CI 0.994–1.000; P = 0.029) were independently associated with impaired MVP. GWI showed a good sensitivity (86.8%) but low specificity (53.7%) in identifying impaired MVP (AUC 0.712, 95% CI 0.620–0.804; P < 0.001). Combination with GWI can improve the diagnostic value of TNI or LVEVi for impaired MVP. Conclusion Impaired MVP is relatively common in STEMI patients after revascularization and independently associated with left ventricular GWI assessed by echocardiography. GWI confer incremental value to MVP assessment in STEMI patients.https://doi.org/10.1186/s12872-022-02648-zMyocardial infarctionLeft ventricular myocardial workMyocardial contrast echocardiographyMicrovascular perfusion
spellingShingle Wenying Jin
Lan Wang
Tiangang Zhu
Yuliang Ma
Chao Yu
Feng Zhang
Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
BMC Cardiovascular Disorders
Myocardial infarction
Left ventricular myocardial work
Myocardial contrast echocardiography
Microvascular perfusion
title Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
title_full Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
title_fullStr Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
title_full_unstemmed Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
title_short Usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in STEMI patients after revascularization
title_sort usefulness of echocardiographic myocardial work in evaluating the microvascular perfusion in stemi patients after revascularization
topic Myocardial infarction
Left ventricular myocardial work
Myocardial contrast echocardiography
Microvascular perfusion
url https://doi.org/10.1186/s12872-022-02648-z
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