Assessing myocardial work to predict left ventricular remodeling after ST-segment elevation myocardial infarction: associations with left atrial and left ventricular strain

Abstract Background Left ventricular ejection fraction (LVEF) is the standard marker for systolic function, but it fails to detect subtle changes in myocardial contractility in patients after an ST-elevation myocardial infarction (STEMI). Thus, a new way to evaluate left ventricular (LV) function with high precision is needed to assess disease progression and guide therapeutic interventions. This study evaluates the prognostic significance of left atrial (LA) strain, LV strain, and myocardial work in patients who have undergone primary percutaneous coronary intervention (pPCI) post-STEMI. Methods The study population was 100 patients diagnosed with STEMI, all of whom received pPCI for their first STEMI event. Patients were admitted to one of two centers, the cardiology department of Fayoum University in Egypt or the cardiac center at King Fahd University Hospital in Saudi Arabia, between November 2022 and March 2024. Conventional echocardiography and 2D speckle-tracking echocardiography (2D-STE) were performed on each participant within 24 h after pPCI and then repeated at least 6 months later. Myocardial work parameters, the global work index, global constructive work (GCW), global wasted work, and global work efficiency and LA strain parameters were derived from 2D-STE and analyzed for their association with subsequent LV remodeling. Results Myocardial work parameters (e.g., global longitudinal strain) were associated with LV remodeling after STEMI treated with pPCI, with GCW showing the most significant association with LV remodeling among the myocardial work indices evaluated. Furthermore, LV remodeling was associated with significantly impaired cardiac structure and function. Patients who developed LV remodeling exhibited higher LV volumes, lower LVEFs, impaired myocardial work parameters, and longer door-to-balloon times than those without remodeling. Additionally, LA function (e.g., LA ejection fraction) was significantly compromised in the remodeling group. Conclusions Myocardial work and strain parameters were associated with LV remodeling after STEMI treated with pPCI. GCW demonstrated the strongest association with LV remodeling in the present cohort.