Advanced Stress Echocardiography with Cardiopulmonary Exercise Testing After Myocardial Infarction

Background: A thorough post-myocardial infarction (MI) evaluation is essential for prognosis and rehabilitation. While cardiopulmonary exercise testing (CPET) is the standard for assessing functional capacity, combining it with dynamic stress echocardiography (DSE) may offer a more comprehensive assessment. Aim: This study examined the role of stress echocardiography (SE) in male post-MI patients by evaluating left ventricular function with conventional indices and the change in global longitudinal strain (ΔGLS) at rest and during maximal treadmill CPET. A secondary aim was to determine whether ΔGLS could provide additional value to traditional measures in post-MI care. Methods: Eighteen men with a recent MI [15 ST-elevation MI, three non-ST-elevation MI; mean age 53.2 ± 5.9 years, mean body mass index (BMI) 27.9 ± 2.2, 44.4% with a smoking history) and 18 age-matched male controls (mean age 50.1 ± 10.8 years, mean BMI 26.5 ± 2.4, 39.0% with smoking history) were enrolled. All MI patients were under optimal medical therapy, including β-blockers, which were withheld on the test day. Most underwent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) n = 2, or PCI for non-ST-elevation MI (NSTEMI) n = 3. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were measured at rest and at peak effort and correlated with CPET parameters. Results: Post-MI patients had lower LVEF (50.6% vs. 60.7% at rest; 55.3% vs. 67.4% at peak, both p < 0.001), impaired GLS (-14.7% vs. -20.2% at rest, p = 0.003; -15.8% vs. -22.7% at peak, p = 0.001), and reduced VO₂peak (29.2 vs. 41.9 mL/kg/min, p < 0.001) compared with controls. In the MI group, ΔGLS correlated with VO₂peak (r = -0.645, p = 0.003) and VE/VCO₂ (r = 0.539, p = 0.020), indicating its potential as a marker of functional reserve. Conclusions: Combined CPET and SE offered comprehensive insights into functional and myocardial performance, identifying ΔGLS as a useful non-invasive index for risk stratification and rehabilitation after MI, with high feasibility and safety.