The combined assessment of mechanical dispersion and global wasted work identified a high-risk subgroup post-STEMI, with MACE rates of 66.7% in patients with high MD and high GWW.
Does the combined assessment of mechanical dispersion and global wasted work enhance risk prediction for MACE in patients post-STEMI?
The combined echocardiographic assessment of mechanical dispersion and global wasted work effectively stratifies risk in post-STEMI patients, identifying a subgroup at significantly higher risk for adverse cardiac events.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Mechanical dispersion (MD) and global wasted work (GWW) are emerging echocardiographic markers reflecting myocardial dyssynchrony and mechanical inefficiency, respectively. Both have been individually linked to adverse outcomes following acute ST-segment elevation myocardial infarction (STEMI). However, their interrelationship and combined prognostic value remain underexplored. Purpose To evaluate the prognostic utility of combined MD and GWW in predicting major adverse cardiac events (MACE) post-STEMI. Methods This prospective study included 119 consecutive patients (78.2% man, mean age 58±11 years) admitted over one year with acute STEMI within 12 hours of symptom onset. All underwent successful primary percutaneous coronary intervention and were evaluated by comprehensive transthoracic echocardiography within 72 hours post-procedure. GWW was quantified using pressure–strain loops, and MD was measured by speckle-tracking echocardiography as the standard deviation of time to peak longitudinal strain. Patients were followed for the occurrence of MACE, defined as ventricular arrhythmias, heart failure hospitalization, all-cause mortality, or new acute coronary syndromes. Results Over a median follow-up of 14 months (interquartile range: 6–32 months), 27 patients experienced MACE. Receiver operating characteristic analysis identified optimal cutoffs of 309.5 mmHg% for GWW and 85.94 ms for MD. Based on these thresholds, patients were stratified into three risk groups: Group 1: low MD + low GWW Group 2: high MD or high GWW Group 3: high MD + high GWW Patients in Group 1 were significantly younger and had more negative global longitudinal strain values, indicating better myocardial function compared to Groups 2 and 3 (p 0.001). Left ventricular ejection fraction did not differ significantly among the groups. The Chi-square test revealed a significant difference in MACE occurrence across the three groups (χ² = 15.4, p 0.001), with the highest event rate observed in Group 3 (66.7%). Kaplan–Meier survival analysis confirmed the prognostic stratification, showing the poorest event-free survival in the high MD + high GWW group (log-rank χ² = 16.4, p 0.001). Notably, a stronger correlation between GWW and MD was observed among patients who developed MACE (r = 0.670, p 0.001) compared to those who did not (r = 0.298, p = 0.004), with Fisher’s z-test confirming a significant difference in correlation strength (z = 2.19, p = 0.029). Conclusion The combined assessment of MD and GWW enhances risk stratification in post-STEMI patients, identifying a high-risk subgroup with significantly increased rates of adverse cardiac events. These findings support the integrated use of mechanical indices in early echocardiographic evaluation to guide prognostic assessment.
Frisan et al. (Thu,) reported a other. The combined assessment of mechanical dispersion and global wasted work identified a high-risk subgroup post-STEMI, with MACE rates of 66.7% in patients with high MD and high GWW.