Global Work Efficiency e prognóstico a longo prazo em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST
Global Work Efficiency e prognóstico a longo prazo em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST
Data
2021
Autores
Lustosa, Rodolfo de Paula
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
INTRODUÇÃO: O strain global longitudinal (SGL) do ventrículo esquerdo (VE) tem demonstrado valor prognóstico adicional sobre a fração de ejeção (FE) do VE em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST). Entretanto, o SGL não leva em consideração o efeito da pós-carga. Novos índices da função cardíaca baseados no trabalho miocárdico integram as medidas da pressão arterial (pós-carga) com SGL. OBJETIVO: Investigar o valor prognóstico do global work efficiency (GWE) (refletindo a performance do VE) em pacientes com IAMCSST, através da obtenção de curvas pressão-strain ao ecocardiograma. MÉTODOS: Um total de 507 pacientes com IAMCSST (média de idade 61±11 anos, 76% sexo masculino), foram retrospectivamente analisados. FEVE e GWE foram medidos pelo ecocardiograma nas primeiras 48 horas de admissão. GWE foi definido como a razão entre o trabalho construtivo dividido pela soma do trabalho construtivo e do trabalho desperdiçado em todos os segmentos do VE, e expresso em percentagem. Uma análise pela curva spline foi utilizada para definir a associação entre GWE reduzido e mortalidade global. RESULTADOS: Após uma mediana de seguimento de 80 meses (intervalo interquartil 67-97 meses), 40 (8%) pacientes morreram. Pacientes com GWE reduzido (<86%) mostraram risco elevado para mortalidade global (17.5% vs. 4.7%; log-rank p<0.001) em comparação com pacientes com GWE preservado (≥86%). GWE reduzido (<86%) demonstrou uma associação independente com mortalidade global (HR 3.167; 95%IC 1.679-5.972;p<0.001). CONCLUSÃO: GWE reduzido (<86%) medido pela ecocardiografia transtorácica nas primeiras 48 horas de admissão em pacientes com IAMCSST foi associado com pior prognóstico a longo prazo. Palavras-chave: Infarto agudo do miocárdio com supradesnível do segmento ST, eficiência global do trabalho miocárdico do ventrículo esquerdo, prognóstico
INTRODUCTION: Left ventricular (LV) global longitudinal strain (GLS) has demonstrated incremental prognostic value over LV ejection fraction (EF) in patients with ST-segment elevation myocardial infarction (STEMI). However, LV GLS does not take into consideration the effect of afterload. Novel speckle tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV GLS. OBJECTIVE: The present study aimed to investigate the prognostic value of global work efficiency (GWE) (reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with STEMI. METHODS: A total of 507 STEMI patients (mean age 61±11 years; 76% male), were retrospectively analyzed. LVEF and GWE were measured by transthoracic echocardiography within 48 hours of admission. GWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments, and expressed as a percentage. Spline curve analysis was used to define the association between reduced GWE and all-cause death. RESULTS: After a median follow-up of 80 months (interquartile range 67-97 months), 40 (8%) patients died. Patients with reduced GWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% vs. 4.7%; log-rank p<0.001) in comparison with patients with preserved GWE (≥86%). Reduced GWE (<86%) showed an independent association with all-cause mortality (HR 3.167; 95%CI 1.679-5.972; p<0.001). CONCLUSIONS: Reduced GWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in STEMI patients is associated with worse long-term survival. Key Words: ST-segment elevation myocardial infarction, global left ventricular myocardial work efficiency, prognosis.
INTRODUCTION: Left ventricular (LV) global longitudinal strain (GLS) has demonstrated incremental prognostic value over LV ejection fraction (EF) in patients with ST-segment elevation myocardial infarction (STEMI). However, LV GLS does not take into consideration the effect of afterload. Novel speckle tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV GLS. OBJECTIVE: The present study aimed to investigate the prognostic value of global work efficiency (GWE) (reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with STEMI. METHODS: A total of 507 STEMI patients (mean age 61±11 years; 76% male), were retrospectively analyzed. LVEF and GWE were measured by transthoracic echocardiography within 48 hours of admission. GWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments, and expressed as a percentage. Spline curve analysis was used to define the association between reduced GWE and all-cause death. RESULTS: After a median follow-up of 80 months (interquartile range 67-97 months), 40 (8%) patients died. Patients with reduced GWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% vs. 4.7%; log-rank p<0.001) in comparison with patients with preserved GWE (≥86%). Reduced GWE (<86%) showed an independent association with all-cause mortality (HR 3.167; 95%CI 1.679-5.972; p<0.001). CONCLUSIONS: Reduced GWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in STEMI patients is associated with worse long-term survival. Key Words: ST-segment elevation myocardial infarction, global left ventricular myocardial work efficiency, prognosis.
Description
Palavras-chave
Infarto Agudo do Miocárdio com Supradesnível, Infarto agudo do miocárdio com supradesnível do segmento ST, Eficiência Global do Trabalho Miocárdico do Ventrículo Esquerdo, Prognóstico, ST-Segment Elevation Myocardial Infarction, Global Left Ventricular Myocardial Work Efficiency, Prognosis
Citação
Lustosa RP. Global Work Efficiency e prognóstico a longo prazo em pacientes com infarto agudo do miocárdio com supradesnível do segmento ST. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2021.