The Good, the Bad, and the Ugly of Using Left Ventricular Longitudinal Myocardial Deformation by Speckle-Tracking Echocardiography to Assess Patients After an Acute Myocardial Infarction
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Timely reperfusion, effective mechanical recanalization of the obstructed coronary arteries, and aggressive antiplatelet therapy have dramatically improved the prognosis of patients with acute ST-segment–elevation myocardial infarction (STEMI).1 Although no study has formally examined temporal trends in the prevalence of moderate to severe left ventricular (LV) systolic dysfunction after STEMI, it is likely that modern management of STEMI may have increased the proportion of patients who survive with only modest impairment of LV systolic function. However, not all survivors of a STEMI with normal or only modestly reduced LV ejection fractions have either a preserved systolic function or a favorable prognosis. Thus, a measure of systolic function in the setting of preserved LV ejection fraction that identifies high-risk STEMI patients could potentially be applied to identify those patients who may benefit from closer clinical monitoring, more aggressive management, and could be selected for future randomized studies testing new therapies.
See Article by Joyce et al
In this issue of the Circulation: Cardiovascular Imaging, Joyce et al2 report about a large cohort of patients with first STEMI treated with primary percutaneous coronary intervention who were followed for 5.2 years to assess the effects of myocardial function and body size (namely body mass index [BMI]) on outcome defined as all-cause mortality. Interestingly, despite similar mild reduction in LV ejection fraction (46±9%, 48±9%, and 47±9%, respectively) in normal/underweight (BMI<25 kg/m2), overweight (25 kg/m2≤BMI<30 kg/m2), and obese (BMI≥30 kg/m2 …