Predictive significance of modern echocardiographic parameters, stress ultrasound of the lungs in patients with acute myocardial infarction and percutaneous coronary intervention
Authors: Safarova A , Kobalava Z H , Timofeeva T 
Published: November 2023

Abstract

Introduction
Improving the EF can reduce the risk of cardiovascular complications (CVC) in postinfarction period. Short-term periprocedural dynamics (PPD) of EF and its prognostic value in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) have not been studied. Stress lung ultrasound (LUS) can be used as an initial step in heart failure (HF) risk stratification. Speckle tracking Echo with assessment of myocardial work (MW) is promising in relation to the prediction of CVC in patients with AMI. The predictive abilities of 3D Echo deformity and rotation in patients with AMI are not well studied.

Purpose
Determination of the value of PPD EF, subclinical pulmonary congestion (PC) in stress LUS, parameters of MW and 3D-Echo in the prognosis of the development of CVC in long-term period in patients with the first AMI and PCI.

Methods
In 131 patients (89 men, mean age: 61.7±11.45 years, Me EF admission: 48%, multivessel coronary artery disease 66.4%) with a first MI without a history of HF with successful PCI, EF was assessed before PCI and at discharge, MW parameters, 3D-Echo parameters were determined, and stress LUS with physical activity was performed. An increase in EF&gt;5% and an achievement of 50% or more were taken as a criterion for a positive PPD. After 3 months, the dynamics of 2- and 3D-Echo were evaluated. The observation period was 550 days. Hospitalization with HF, CV death, and composite point were assessed.

Results
Upon admission baseline EF&lt;50% was detected in 56.5% of cases. 47.3% of patients from the group with baseline EF &lt;50% did not have PPD EF after PCI, which is associated with an increased risk of hospitalization with HF (HR=7.13 p=0.004). An increase in PPD by 1% reduces the risks of hospitalization with HF by 1.31 times (p=0.013). According to the stress LUS, subclinical PC was detected in 99.1% of patients. In patients with baseline EF &lt;50%, the sum of B-lines ≥10 during exercise increases the risks of hospitalization with HF by 2.4 times, and its combination with the absence of PPD - by 7.45 times during 1.5 years. With GLS&lt;13.7%, the risk of hospitalization with HF increases by 2.34 times (p=0.048), GWW&gt;161.5 mmHg% - by 2.65 times (p=0.028). The model for calculating the risk of hospitalization with HF included GLS (OR 0.75; p=0.006), GCW (OR 0.85; p=0.036) and ΔEF (OR 0.88; p=0.040). Patients hospitalized with HF after AMI showed a significant increase in the LV sphericity index after 3 months. The predictors of hospitalization with HF according to 3D Echo were indicators of circumflexial strain (CS)(OR 0.76; p=0.026), areal strain (AS)(OR 0.60; p=0.012), radial strain (RS)(OR 0.91; p=0.039), area strain dynamics over 3 months (HR 0.702; р=0.025).

Conclusion
In patients with the first AMI, it is advisable to conduct a comprehensive Echo with an assessment of MW, stress LUS to identify high-risk patients for the development of HF in the postinfarction period.