Assessing Echocardiographic Predictors Of Mechanical Complications And Clinical Prognosis In Acute Myocardial Infarction

Abstract

Background: Acute myocardial infarction (AMI) is still one of the leading causes of cardiovascular death worldwide and life-threatening mechanical complications despite impressive advances in reperfusion therapy significantly contribute to the clinical outcome. Echocardiography plays an essential role in the early diagnosis, risk stratification and prognosis of post-AMI structural complications. The objective of this study is to review systematically the echocardiographic predictors of mechanical complications to allow timely clinical intervention and to enhance patient survival.

Methods: Retrospective observational cohort study was conducted in University of Lahore teaching hospital and Gulab Devi hospital for four months period. Random sampling was used to enroll a total of 84 patients with confirmed AMI (STEMI or NSTEMI) based on clinical presentation, ECG changes and elevated cardiac biomarkers. All patients had a transthoracic echocardiogram in their primary admission. Data were gathered from the Electronic Medical Records and analyzed with SPSS version 27 and were echocardiography and clinical data.

Results: The cohort comprised 84 patients (mean age 56.25 ± 9.28 years; 61.9% male). The most common type of infarction was STEMI (91.7%). This association of VSR with posterior infarction was statistically significant and was only observed in STEMI patients (p = 0.072 at the exploratory level of 0.10). There was a tendency for association with lateral infarction for free wall rupture (p = 0.089). Mitral regurgitation, left ventricular aneurysm formation were seen in 66.7% and 55.95% of the patients, respectively, and there was no significant association with the types of AMI. Sixty-three percent of the population had an LVEF less than 45%. Throughout, the comorbidity burden was high, with pulmonary hypertension (≈60%), heart failure (>50%) and chronic kidney disease (>40%).

Conclusion: The conclusion is that the site and type of AMI are important factors in determining specific mechanical complications. Posterior STEMI is highly correlated with VSR, and lateral infarction can be considered a risk factor for free wall rupture. The mitral regurgitation and LV aneurysm are thought to be indicators of generalized ischemic myocardial injury. Personalized post-AMI care and timely lifesaving interventions require comprehensive echocardiographic evaluation, which includes comprehensive infarct topography and a detailed profile of the comorbidities.