Global myocardial work efficiency provides incremental prognostic value in STEMI patients undergoing PCI

Alexandra-Cătălina Frişan; Raluca Coifan; Mihai-Andrei Lazăr; Oana Voinescu; Daniel-Miron Brie; Alexandru Tîrziu; Alexandru Silvius Pescariu; Dragoş Constantin Cozma; Silvia-Ana Luca; Cristian Mornoş

doi:10.2478/rjc-2026-0004

Figures & Tables

Myocardial work analysis in a patient with acute anterior myocardial infarction, showing reduced myocardial work indices (GWI, GCW, GWE), elevated GWW and impairment of GLS. Abbreviations: GLS, global longitudinal strain; GWI, global work index; GCW, global constructive work; GWE, global work efficiency; BP, blood pressure.

Incremental prognostic value of GWE for MAE. The bar chart shows –2 log likelihood for three sequential Cox models: the baseline clinical model (age, Killip class and eGFR), the model adding LVEF, and the model further including GWE. Data labels indicate the Akaike information criterion for each model. Addition of LVEF resulted in a minimal and non-significant improvement in model fit (likelihood ratio X2= 0.03, df =1, P = 0.85). Further inclusion of GWE produced a substantial reduction in –2LL, significantly improving model fit (likelihood ratio X2 = 4.90, df = 1, p = 0.02). GWE, global work efficiency; –2LL, –2 log likelihood; LR, likelihood ratio; eGFR, estimated glomerullar filtration rate; LVEF, left ventricular ejection fraction; AIC, akaike information criterion.

Transthoracic echocardiography results_

Echocardiographic parameters	All (n = 215)	No events (n = 175)	MAE (n = 40)	P value
LVEDV, ml	107 ± 26	108 ± 27	113 ± 30	0.276
LVESV, ml	65 (45–75)	62 (52–73)	60 (45–74)	0.568
LA diameter, mm	40 ± 5.5	39 ± 4.9	40 ± 4.7	0.827
LAVi, mL/m²	55.78 ± 19.86	29.55 ± 9.89	29.94 ± 10.10	0.785
RV diameter, mm	26 ± 3.0	25 ± 3.4	26 ± 3.9	0.212
PASP, mmHg	22 (21–31)	21 (21–28)	23 (18–30)	0.324
TAPSE, mm	20 ± 2.8	26 ± 1.7	20 ± 3.8	0.466
IVST, cm	1.17 ± 0.15	1.20 ± 0.19	1.13 ± 0.15	0.370
PWT, cm	1.12 ± 0.12	1.14 ± 0.15	1.11 ± 0.17	0.279
AV Pmax, m/s	4.8 (4.0–7.0)	5.2 (4.0–7.0)	5.2 (4.0–6.1)	0.236
E wave, m/s	0.64 ± 0.20	0.63 ± 0.19	0.64 ± 0.18	0.742
A wave, m/s	0.78 ± 0.18	0.76 ± 0.17	0.73 ± 0.19	0.467
Mean E’, m/s	0.06 ± 0.01	0.06 ± 0.01	0.06 ± 0.01	0.786
E/E’ ratio	10.57 (8.30–12.57)	9.33 (7.69–12.15)	10.61 (8.31–15.30)	0.633
Mean S’, m/s	0.07 ± 0.01	0.07 ± 0.01	0.07 ± 0.01	0.125
LVEF, %	41 ± 6	43 ± 6	42 ± 6	0.708
GLS, %	-12.21 ± 3.51	-12.77 ± 3.3	-11.75 ± 3.44	0.081
MD, ms	67.60 (54.40–83.33)	67.80 (54.06–83.33)	66.95 (51.25–83.57)	0.123
GWI, mmHg%	1105 ± 479	1210 ± 433	1077 ± 474	0.086
GCW, mmHg%	1293±493	1392 ± 437	1258 ± 448	0.084
GWW, mmHg%	139 (95–187)	147 (90–187)	126 (96–200)	0.355
GWE, %	86 ± 8	86 ± 7	83 ± 8	0.022

Cox regression analysis to evaluate the risk of major adverse events during follow-up_

Parameter	Unit interpretation	P	HR¹	Univariable 95% CI²	HR	Multivariable 95% CI	P
Age	per 1-year increase	1.010	0.982–1.038	0.486	1.025	0.995–1.057	0.101
Sex	Male/female	0.493	0.193–1.258	0.139
Peak CK-MB³	per 100 U/L increase	1.159	1.039–1.293	0.008	1.126	0.998–1.270	0.054
Creatinine	per 1 mg/dL increase	1.409	0.640–3.106	0.395
Hypertension	Yes/No	0.499	0.265–0.941	0.032	0.426	0.216–0.842	0.014
LVEF⁴	per 1% increase	0.985	0.940–1.033	0.536
GLS⁵	per 1% increase	1.096	0.996–1.207	0.060
MD⁶	per 10 ms increase	1.115	1.000–1.242	0.050
GWI⁷	per 100 mmHg% increase	0.922	0.854–0.996	0.040
GCW⁸	per 100 mmHg% increase	0.922	0.854–0.996	0.039
GWW⁹	per 10 mmHg% increase	1.018	0.992–1.045	0.177
GWE¹⁰	per 5% increase	0.811	0.688–0.955	0.012	0.835	0.693–0.985	0.033
LVEDV¹¹	per 1 mL increase	1.007	0.996–1.018	0.188
LAVi ¹²	per 1 mL/m² increase	1.004	0.974–1.035	0.792
E/E’¹³	per 1-unit increase	1.024	0.959–1.092	0.480

Baseline clinical characteristics of the study cohort, both overall and according to the occurrence of major adverse events_

Variable	All (n = 215)	No events (n = 175)	MAE (n= 40)	P value
Age, years	61 ± 10	59 ± 10	59 ± 13	0.791
Man, n (%)	168 (78.1)	133 (76)	35 (87.5)	0.122
Heart rate, bpm	80 ± 16	79 ± 15	78 ± 16	0.714
SBP, mmHg	139 ± 22	143 ± 23	140 ± 23	0.451
DBP, mmHg	86 ± 14	87 ± 15	87 ± 16	0.801
BMI, kg/m²	27.10 (24.22–30.86)	27.68 (24.5–31.8)	27.23 (24.0–31.0)	0.877
BSA, m²	1.91 (1.79–2.13)	1.97 (1.82–2.16)	1.96 (1.74–2.11)	0.855
Peak CK-MB, U/L	289.60 ± 211	244.14 ± 189.66	353.28 ± 291.45	0.004
Peak Troponin I, ng/L	3,351 (314–21,506)	1,866 (218–18,773)	13,404 (1434–38,967)	0.057
eGFR, ml/min/1.73 m²	74.08 ± 21.22	79.89 ± 20.23	80.28 ± 24.47	0.917
Total Cholesterol, mg/dL	192 ±49	192 ± 43	190 ± 52	0.811
LDLc, mg/dL	121 ± 49	120 ± 32	117 ± 39	0.632
Triglycerides, mg/dL	108 (86–156)	121 (93–168)	123 (85–146)	0.806
Hemoglobin, g/dL	14.80 ± 1.64	14.69 ± 1.47	14.58 ± 1.53	0.656
Creatinine, mg/dL	1.08 (0.92–1.30)	1.09 (0.96–1.24)	1.16 (0.85–1.28)	0.669
Glycemia, mg/dL	132 (113–176)	132 (113–167)	128 (110–160)	0.186
Leucocytes, 10³ / μL	12.03 (10.24–14.95)	12.03 (9.93–14.41)	11.97 (9.78–15.94)	0.448
Neutrophiles, 10³ / μL	9.56 (7.40–11.28)	8.75 (7.11–11.28)	9.19 (6.99–13.16)	0.436
ESR, mm/h	10 (6-20)	10 (6-22)	12 (10-29)	0.667
Smoking, n (%)	157 (73)	129 (73.7)	28 (70.0)	0.633
Dyslipidemia, n (%)	209 (97.2)	171 (97.7)	38 (95)	0.347
Previous CAD, n (%)	14 (6.5)	12 (6.9)	2 (5.0)	1.000
Cardiac inheritance, n (%)	14 (6.5)	13 (7.4)	1 (2.5)	0.476
Diabetes, n (%)	47 (21.9)	39 (22.3)	8 (20.0)	0.752
Hypertension, n (%)	154 (71.6)	130 (74.3)	24 (60.0)	0.071
Killip Class I, n (%)	177 (82.3)	149 (85.1)	28 (70)	0.024
Killip Class II, n (%)	30 (14)	21 (12)	9 (22.5)	0.084
Killip Class III, n (%)	3 (1.4)	1 (0.6)	2 (0.5)	0.090
Killip Class IV, n (%)	5 (2.3)	4 (2.3)	1 (2.5)	1.000
CKD, n (%)	22 (10.2)	16 (9.1)	6 (15.0)	0.259
Thrombolysis, n (%)	56 (26.0)	45 (25.7)	11 (27.5)	0.816
Single-vessel disease, n (%)	90 (41.9)	81 (46.3)	9 (22.5)	0.006
Two-vessel disease, n (%)	74 (34.4)	59 (33.7)	15 (37.5)	0.649
Three-vessel disease, n (%)	51 (23.7)	35 (20.0)	16 (40.0)	0.007
Anterior STEMI, n (%)	91 (42.3)	75 (42.9)	16 (40.0)	0.741
Treatment at discharge
Aspirin, n (%)	212 (98.6)	173 (98.9)	39 (97.5)	0.462
P2Y₁₂i, n (%)	215 (100)
Betablocker, n (%)	169 (78.6)	140 (80.0)	29 (72.5)	0.297
Nitrate, n (%)	92 (42.8)	69 (39.4)	23 (57.5)	0.037
ACE inhibitor, n (%)	125 (58.1)	109 (62.3)	16 (40.0)	0.010
ARBs, n (%)	1 (0.5)	1 (0.6)	0 (0.0)	1.000
MRAs, n (%)	170 (79.1)	136 (77.7)	34 (85.0)	0.307
Furosemide, n (%)	159 (74.0)	123 (70.3)	36 (90.0)	0.010
SGLT2i, n (%)	44 (20.5)	37 (21.1)	7 (17.5)	0.606
ARNI, n (%)	7 (3.3)	5 (2.9)	2 (5.0)	0.617
Statins, n (%)	215 (100)

Global myocardial work efficiency provides incremental prognostic value in STEMI patients undergoing PCI

Figures & Tables

Figure 1

Figure 2

Transthoracic echocardiography results_

Cox regression analysis to evaluate the risk of major adverse events during follow-up_

Baseline clinical characteristics of the study cohort, both overall and according to the occurrence of major adverse events_

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