The roles of quantitative doppler echocardiography in optimizing guideline-directed medical therapy in Post-STEMI patients

Abstract Patients with ST-segment elevation myocardial infarction (STEMI), who are at the highest risk, benefit the most from early guideline-directed medical therapy (GDMT). In real-world practice, timely application and titration of these medications are often compromised during the immediate post-STEMI period due to the perception of hemodynamic instability. An extended medication gap may last from the early post-STEMI period until outpatient follow-up weeks later, depriving prognostic benefit from key pharmacotherapy in the critical window of early post-infarct course. We discuss the practical hurdles in the post-STEMI period to commence GDMT, and the tactics to optimize risk management in high-risk patients to realize the benefits of GDMT. We highlight the challenges of real-time cardiac preload evaluation after coronary revascularization, and the emerging roles of quantitative Doppler echocardiography a point-of-care non-invasive imaging approaches in guiding preload titration to support early pharmacotherapy. We propose stepwise algorithms to integrate instantaneous quantitative Doppler assessment into routine post-STEMI management workflow, and outline our perspective for future trial design and clinical practice.