1
|
Kim KA, Kim SH, Lee KY, Yoon AH, Hwang BH, Choo EH, Kim JJ, Choi IJ, Kim CJ, Lim S, Park MW, Yoo KD, Jeon DS, Ahn Y, Jeong MH, Chang K. Predictors and Long-Term Clinical Impact of Heart Failure With Improved Ejection Fraction After Acute Myocardial Infarction. J Am Heart Assoc 2024; 13:e034920. [PMID: 39158557 DOI: 10.1161/jaha.124.034920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Little is known about the characteristics and long-term clinical outcomes of patients with heart failure with improved ejection fraction (HFimpEF) after acute myocardial infarction. METHODS AND RESULTS From a multicenter, consecutive cohort of patients with acute myocardial infarction undergoing percutaneous coronary intervention, patients with an initial echocardiogram with left ventricular ejection fraction ≤40% and at least 1 follow-up echocardiogram after 14 days and within 2 years of the initial event were considered for analyses. HFimpEF was defined as an initial left ventricular ejection fraction ≤40% and serial left ventricular ejection fraction >40% with an increase of ≥10% from baseline at follow-up. Independent factors predicting HFimpEF were identified, and clinical outcomes of patients with HFimpEF were compared with those without improvement. From an initial cohort of 10 719 patients with acute myocardial infarction, 191 patients with HFimpEF and 256 patients with non-HFimpEF who had initial and follow-up echocardiographic data were analyzed. The median follow-up duration was 4.5 (interquartile range, 2.9-5.0) years. The factors predicting HFimpEF were lower peak creatine kinase myocardial band, smaller left ventricular dimensions, lower ratio between early mitral inflow velocity and mitral annular early diastolic velocity ', and the use of β blockers or renin-angiotensin system blockers at discharge. HFimpEF was associated with a significantly decreased risk of all-cause death compared with non-HFimpEF (hazard ratio, 0.377 [95% CI, 0.234-0.609]; P<0.001). In 2-year landmark analysis, these findings were consistent not only before but also after the landmark point. Similar findings were true for cardiovascular death and admission for heart failure. CONCLUSIONS Patients with HFimpEF after acute myocardial infarction showed distinct clinical and echocardiographic characteristics and were associated with better long-term clinical outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02806102.
Collapse
Affiliation(s)
- Kyung An Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital The Catholic University of Korea Incheon Republic of Korea
| | - Sang Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
- Division of Cardiology, Department of Internal Medicine The Armed Forces Capital Hospital Seongnam Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Andrew H Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Jin Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital The Catholic University of Korea Incheon Republic of Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital The Catholic University of Korea Uijeongbu Republic of Korea
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital The Catholic University of Korea Uijeongbu Republic of Korea
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital The Catholic University of Korea Daejeon Republic of Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital The Catholic University of Korea Suwon Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine The Armed Forces Capital Hospital Seongnam Republic of Korea
| | - Youngkeun Ahn
- Cardiovascular Center Chonnam National University Hospital, Chonnam National University Gwangju Republic of Korea
| | - Myung Ho Jeong
- Cardiovascular Center Chonnam National University Hospital, Chonnam National University Gwangju Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| |
Collapse
|
2
|
Yang Y, Dong YZ, Hou AX, Liu DP, He JW, Chen JY, Jiang XH. Establishment and validation of a prediction model for nonrecovery of left ventricular ejection fraction in acute myocardial infarction patients combined with decreased left ventricular ejection fraction. Clin Cardiol 2024; 47:e24212. [PMID: 38402553 PMCID: PMC10823450 DOI: 10.1002/clc.24212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND This study aimed to investigate the risk factors for nonrecovery of left ventricular ejection fraction (LVEF) during follow-up in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) combined with reduced LVEF, and establish and verify a risk prediction model based on these factors. METHODS In this study, patients with AMI who underwent PCI in a high-volume PCI center between December 2018 and December 2021 were consecutively enrolled, screened, and randomly assigned to the model establishment and validation cohorts. A predictive model method based on least absolute shrinkage and selection operator regression was used for establishment and validation. RESULTS Cardiac troponin I, myoglobin, left ventricular end-diastolic dimension, multivessel disease, and no-reflow were identified as potential predictors of LVEF recovery failure. The areas under the curve were 0.703 and 0.665 in the model establishment and validation cohorts, respectively, proving that the prediction model had some predictive ability. The calibration curves of the two cohorts showed good agreement with those of the nomogram model. In addition, the decision curve analysis showed that the model had a net clinical benefit. CONCLUSION This prediction model can assess the risk of nonrecovery of LVEF in patients with AMI undergoing PCI combined with LVEF reduction during follow-up, and conveniently screen high-risk patients with nonrecoverable LVEF early.
Collapse
Affiliation(s)
- Yang Yang
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - You Zheng Dong
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - An Xue Hou
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - De Ping Liu
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - Jin Wu He
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - Jun Ye Chen
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| | - Xing Hua Jiang
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina
| |
Collapse
|
3
|
Yehia A, Zaki A, Sadaka M, Azeem AMAE. Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI). Echocardiography 2024; 41:e15725. [PMID: 38078679 DOI: 10.1111/echo.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. METHODS One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6 weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. RESULTS The mean change of EF was 8.04 ± 3.32% in group I versus -.39 ± 5.09 % in group II (p < .001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6 weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p < .001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. CONCLUSIONS Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.
Collapse
Affiliation(s)
- Ahmed Yehia
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Zaki
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sadaka
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | |
Collapse
|
4
|
Heidari Moghadam R, Salehi N, Mahmoudi S, Shojaei L, Nasiri S, Siabani S, Janjani P, Rouzbahani M, Tadbiri H, Nalini M. Determinants of Left Ventricular Systolic Function One Year after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in a Middle-Income Country. ARCHIVES OF IRANIAN MEDICINE 2023; 26:92-99. [PMID: 37543929 PMCID: PMC10685896 DOI: 10.34172/aim.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/28/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Little is known about the predictors of left ventricular ejection fraction (LVEF) -an important predictor of mortality- after primary percutaneous coronary intervention (PCI) in low- and middle-income countries. METHODS In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models. RESULTS Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively). CONCLUSION Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries.
Collapse
Affiliation(s)
- Reza Heidari Moghadam
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Susan Mahmoudi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Lida Shojaei
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Sirus Nasiri
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Soraya Siabani
- Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Hooman Tadbiri
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| |
Collapse
|
5
|
Wohlfahrt P, Jenča D, Melenovský V, Šramko M, Kotrč M, Želízko M, Mrázková J, Adámková V, Pitha J, Kautzner J. Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions. Front Cardiovasc Med 2022; 9:1051995. [PMID: 36451922 PMCID: PMC9702523 DOI: 10.3389/fcvm.2022.1051995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/27/2022] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI. METHODS Data from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized. RESULTS Out of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. CONCLUSIONS Despite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.
Collapse
Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- First Medical School, Charles University, Prague, Czechia
| | - Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Third Medical School, Charles University, Prague, Czechia
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Martin Kotrč
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Jolana Mrázková
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Jan Pitha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Medical and Dentistry School, Palacký University, Olomouc, Czechia
| |
Collapse
|
6
|
Hanada K, Sasaki S, Seno M, Kimura Y, Ichikawa H, Nishizaki F, Yokoyama H, Yokota T, Okumura K, Tomita H. Reduced Left Ventricular Ejection Fraction Is a Risk for Sudden Cardiac Death in the Early Period After Hospital Discharge in Patients With Acute Myocardial Infarction. Circ J 2022; 86:1490-1498. [PMID: 35314579 DOI: 10.1253/circj.cj-21-0999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND The incidence of sudden cardiac death (SCD) after discharge in Japanese acute myocardial infarction (AMI) patients with reduced left ventricular ejection fraction (LVEF) treated with primary percutaneous coronary intervention (PCI) remains unknown. METHODS AND RESULTS The study population included 1,429 AMI patients (199 with LVEF ≤35% and 1,230 with LVEF >35%) admitted to the Hirosaki University Hospital, treated with primary PCI within 12 h after onset, and survived to discharge. LVEF was evaluated in all patients before discharge, and the patients were followed up for a mean of 2.6±0.8 years. The Kaplan-Meier survival curves revealed LVEF ≤35% was associated with all-cause death and SCD. The incidence of SCD was 2.6% at 1 year and 3.1% at 3 years in patients with LVEF ≤35%, whereas it was 0.1% at 1 year and 0.3% at 3 years in patients with LVEF >35%. Sixty-seven percent of SCDs in patients with LVEF ≤35% occurred within 4 months after discharge, and the events became less frequent after this period. A Cox proportional hazard model indicated LVEF ≤35% as an independent predictor for all-cause death and SCD. CONCLUSIONS The incidence of SCD was relatively low in Japanese AMI patients treated with primary PCI, even in patients with LVEF ≤35% upon discharge. Careful management of patients with reduced LVEF is required to prevent SCD, especially in the early phase after discharge.
Collapse
Affiliation(s)
- Kenji Hanada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Maiko Seno
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Yoshihiro Kimura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Hiroaki Ichikawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Takashi Yokota
- Department of Advanced Cardiovascular Therapeutics, Hirosaki University Graduate School of Medicine
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
- Department of Advanced Cardiovascular Therapeutics, Hirosaki University Graduate School of Medicine
| |
Collapse
|
7
|
Lei Z, Li B, Li B, Peng W. Predictors and prognostic impact of left ventricular ejection fraction trajectories in patients with ST-segment elevation myocardial infarction. Aging Clin Exp Res 2022; 34:1429-1438. [PMID: 35147922 PMCID: PMC9151544 DOI: 10.1007/s40520-022-02087-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/27/2022] [Indexed: 12/28/2022]
Abstract
Background There is little evidence on left ventricular ejection fraction (LVEF) trajectories after ST-segment elevation myocardial infarction (STEMI). Aim We aim to identify the LVEF trajectories after STEMI and explore their predictors and association with prognosis. Methods This is a retrospective, observational study of STEMI patients. The LVEF trajectories were identified by the latent class trajectory model in patients with baseline LVEF < 50%. We used logistic regression analysis to investigate the predictors for LVEF trajectories. The Cox proportional hazard model was used to assess the impact of LVEF trajectories on prognosis. The primary outcomes were cardiovascular mortality and heart failure (HF) rehospitalization. Results 572 of 1179 patients presented with baseline normal LVEF (≥ 50%) and 607 with baseline reduced LVEF (< 50%). Two distinct LVEF trajectories were identified in patients with baseline reduced LVEF: recovered LVEF group and persistently reduced LVEF group. Higher baseline LVEF, lower peak troponin T, non-anterior MI, and lower heart rates were all found to be independently associated with LVEF recovery. After multivariate adjustments, patients with persistently reduced LVEF experienced an increased risk of cardiovascular mortality (HR 7.49, 95% CI 1.94–28.87, P = 0.003) and HF rehospitalization (HR 3.54, 95% CI 1.56–8.06 P = 0.003) compared to patients with baseline normal LVEF. Patients with recovered LVEF, on the other hand, showed no significant risk of cardiovascular mortality and HF rehospitalization. Conclusion Our study indicated two distinct LVEF trajectories after STEMI and that the persistently reduced LVEF trajectory was related to poor prognosis. In addition, several baseline characteristics can predict LVEF recovery. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02087-y.
Collapse
Affiliation(s)
- Zhijun Lei
- Department of Cardiology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Bingyu Li
- Department of Cardiology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Bo Li
- Department of Cardiology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Wenhui Peng
- Department of Cardiology, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, 301 Middle Yanchang Road, Shanghai, 200072, China.
| |
Collapse
|
8
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 710] [Impact Index Per Article: 355.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ursaru AM, Petris AO, Costache II, Nicolae A, Crisan A, Tesloianu ND. Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD-What We Still Don't Know. J Cardiovasc Dev Dis 2022; 9:120. [PMID: 35448096 PMCID: PMC9028370 DOI: 10.3390/jcdd9040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation.
Collapse
Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Antoniu Octavian Petris
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Ana Nicolae
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Adrian Crisan
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| |
Collapse
|
10
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 876] [Impact Index Per Article: 438.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
|
11
|
Tabaee S, Sahebkar A, Aghamohammadi T, Pakdel M, Dehabeh M, Sobhani R, Alidadi M, Majeed M, Mirhafez SR. The Effects of Curcumin Plus Piperine Supplementation in Patients with Acute Myocardial Infarction: A Randomized, Double-Blind, and Placebo-Controlled Trial. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1328:199-211. [PMID: 34981479 DOI: 10.1007/978-3-030-73234-9_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a leading cause of death and disability worldwide. Previous investigations have demonstrated that curcumin has a cardioprotective effect and may improve myocardial injury. So this study was performed to assess whether supplementation with curcumin could diminish myocardial injury following AMI. METHODS To conduct this randomized, double-blinded, and placebo-controlled clinical trial, seventy-two patients with acute myocardial infarction, aged 18-75 years, were enrolled and randomly divided into the active intervention and control groups. The active intervention group (n = 38) received curcumin capsules with piperine supplement (500 mg/day, 95% curcuminoids) for 8 weeks, whereas the control group (n = 34) received a placebo capsule. At the baseline and end of the study, ejection fraction was assessed, and blood samples were taken from all patients to measure the levels of cardiac troponin I(cTnI), lipid profile, FBG, HbA1C, liver enzymes, renal function parameters, and electrolytes. RESULTS In this trial, curcumin supplementation significantly reduced the levels of HbA1C (-0.3 ± 2.2 vs. +1.1 ± 1.3, P = 0.002), LDL (-10.3 ± 20.7 vs. +0.2 ± 22.5, P = 0.039), ALT (-10.2 ± 28.5 vs. +7.3 ± 39.2, P = 0.029), and ALP (+6.4 ± 39.5 vs. +38.0 ± 69.0, P = 0.018) compared to the placebo group. Moreover, the serum concentration of HDL significantly improved in comparison with the placebo group (+4.5 ± 8.9 vs. -1.6 ± 7.7, P = 0.002). However, no substantial difference was perceived between the groups regarding the ejection fraction and serum levels of cTnI, FBG, renal function parameters, and electrolytes. CONCLUSION Our results indicated that daily intake of 500 mg of curcumin capsules with piperine supplement for 8 weeks modified lipid profile, liver enzymes, and glycemic status, but did not have any effect on ejection fraction and serum concentration of cardiac troponin I, renal function parameters, and electrolytes in acute myocardial infarction patients.
Collapse
Affiliation(s)
- Samaneh Tabaee
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. .,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Tayebe Aghamohammadi
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Manizhe Pakdel
- Faculty of Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Maryam Dehabeh
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Reza Sobhani
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mona Alidadi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Seyed Reza Mirhafez
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
| |
Collapse
|
12
|
Wilton SB, Bennett MT, Parkash R, Kavanagh K, Jolicoeur EM, Halperin F, Jolly U, Leong-Sit P, Sas R, Chew DS, Singh S, Frisbee S, MacLachlan R, Manlucu J. Variability in Reassessment of Left Ventricular Ejection Fraction After Myocardial Infarction in the Acute Myocardial Infarction Quality Assurance Canada Study. JAMA Netw Open 2021; 4:e2136830. [PMID: 34854904 PMCID: PMC8640891 DOI: 10.1001/jamanetworkopen.2021.36830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Persistently depressed left ventricular ejection fraction (LVEF) after myocardial infarction (MI) is associated with adverse prognosis and directs the use of evidence-based treatments to prevent sudden cardiac death and/or progressive heart failure. OBJECTIVE To assess adherence with guideline-recommended LVEF reassessment and to study the evolution of LVEF over 6 months of follow-up. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter cohort study at Canadian academic and community hospitals with on-site cardiac catheterization services. Patients with type 1 acute MI and LVEF less than or equal to 45% during the index hospitalization were enrolled between January 2018 and August 2019 and were followed-up for 6 months. Data analysis was performed from May 2020 to September 2021. EXPOSURES Baseline clinical factors, in-hospital care and LVEF, and site-specific features. MAIN OUTCOMES AND MEASURES The main outcomes were receipt of repeat LVEF assessment by 6 months and the presence of a persistent LVEF reduction at 2 thresholds: LVEF less than or equal to 40%, prompting consideration of additional medical therapy for heart failure, or LVEF less than or equal to 35%, prompting referral for implanted cardioverter defibrillator in addition to medical therapy. RESULTS This study included 501 patients (mean [SD] age, 63.3 [13.0] years; 113 women [22.6%]). Overall, 370 patients (73.4%) presented with STEMI, and 454 (90.6%) had in-hospital revascularization. The median (IQR) baseline LVEF was 40% (34%-43%). Of 458 patients (91.4%) who completed the 6-month follow-up, 303 (66.2%; 95% CI, 61.7%-70.5%) had LVEF reassessment, with a range of 46.7% to 90.0% across sites (χ213 = 19.6; P = .11). Participants from community hospitals were more likely than those from academic hospitals to undergo LVEF reassessment (73.6% vs 63.2%; χ21 = 4.50; P = .03), as were those with worse LVEF at baseline. Follow-up LVEF improved by an absolute median (IQR) of 8% (3%-15%). However, 103 patients (34.1%) met the definitions of clinically relevant LVEF reduction, including 52 patients (17.2%) with LVEF less than or equal to 35% and 51 patients (16.9%) with LVEF of 35.1% to 40.0%. CONCLUSIONS AND RELEVANCE In this cohort study, approximately 1 in 3 patients with at least mild LVEF reduction after acute MI did not undergo indicated LVEF reassessment within 6 months, suggesting that programs to improve the quality of post-MI care should include measures to ensure that indicated repeat cardiac imaging is performed. In those with follow-up imaging, clinically relevant persistent LVEF reduction was identified in more than one-third of patients.
Collapse
Affiliation(s)
- Stephen B. Wilton
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T. Bennett
- Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ratika Parkash
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katherine Kavanagh
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - E. Marc Jolicoeur
- Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Frank Halperin
- Division of Cardiology, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Umjeet Jolly
- Division of Cardiology, St Mary’s General Hospital, Kitchener, Ontario, Canada
| | - Peter Leong-Sit
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Rozsa Sas
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Singh
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stephanie Frisbee
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Jaimie Manlucu
- Division of Cardiology, Western University, London, Ontario, Canada
| |
Collapse
|
13
|
Somuncu MU, Tatar FP, Kalayci B, Avci A, Gudul NE, Serbest NG, Demir AR, Can M. Role of N-terminal pro-B-type natriuretic peptide and troponin T in predicting right ventricular recovery in myocardial infarction. Horm Mol Biol Clin Investig 2021; 43:27-33. [PMID: 34791860 DOI: 10.1515/hmbci-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery. METHODS One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12-18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1-9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated. RESULTS RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84-0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89-0.98], p=0.014), TnT (OR: 0.84 [0.68-0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10-6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88-0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41-24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59-24.89], p<0.001). CONCLUSIONS Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.
Collapse
Affiliation(s)
- Mustafa Umut Somuncu
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Fatih Pasa Tatar
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Belma Kalayci
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Ahmet Avci
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Naile Eris Gudul
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Nail Guven Serbest
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Murat Can
- Department of Biochemistry, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| |
Collapse
|
14
|
Somuncu MU, Tatar FP, Kalayci B, Avci A, Gudul NE, Uygur B, Demir AR, Can M. Growth Differentiation Factor 15 is Related with Left Ventricular Recovery in Patients with ST-Elevation Myocardial Infarction after Successful Reperfusion by Primary Percutaneous Intervention. ACTA CARDIOLOGICA SINICA 2021; 37:473-483. [PMID: 34584380 DOI: 10.6515/acs.202109_37(5).20210319a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022]
Abstract
Background The determinants of left ventricular (LV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. In addition, the relationship between growth differentiation factor15 (GDF-15) and left ventricular ejection fraction (LVEF) improvement is also unknown. This study hypothesizes that a low GDF-15 level would be associated with LVEF recovery. Methods One hundred and sixty-one STEMI patients were included in this study. Echocardiographic examinations were performed before and 12-18 weeks after discharge. The patients were divided into three groups according to the changes in LVEF as 62 patients with ≥ 10% change, 47 patients with 1-9% change, and 52 patients ≤ 0% change. LV recovery was defined as ≥ 10% LVEF improvement and the predictors of LV recovery were investigated. Moreover, two groups were created according to GDF-15 values, and the follow-up/baseline echocardiographic parameters were compared between these groups. Results LV recovery was detected in 38.5% of the patients. Low baseline LVEF [odds ratio (OR): 0.85, 95% confidence interval (CI) 0.82-0.94, p = 0.001], low GDF-15 (OR: 0.79, 95% CI 0.68-0.93, p = 0.004), previous angina (OR: 2.34, 95% CI 1.10-4.96, p = 0.027), and symptom-to-balloon time (OR: 0.97, 95% CI 0.95-1.00, p = 0.043) were independent predictors of LV recovery. The ratios of follow-up/baseline LV end-diastolic volume index, LV end-systolic volume index and wall motion score index were lower in the low GDF-15 group (0.96 vs. 1.04, p < 0.001; 0.96 vs. 1.10, p < 0.001; 0.89 vs. 0.96, p < 0.001). Moreover, being in the low GDF-15 group was associated with LV recovery (OR: 2.93, 95% CI 1.43-6.02, p = 0.001). Conclusions Lower GDF-15 level was associated with better LV improvement and less adverse remodeling in STEMI patients.
Collapse
Affiliation(s)
- Mustafa Umut Somuncu
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak
| | - Fatih Pasa Tatar
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak
| | - Belma Kalayci
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak
| | - Ahmet Avci
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak
| | - Naile Eris Gudul
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak
| | - Begum Uygur
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul
| | - Murat Can
- Department of Biochemistry, Zonguldak Bulent Ecevit University Faculty of Medicine, Zounguldak, Turkey
| |
Collapse
|
15
|
Raj P, Sayfee K, Parikh M, Yu L, Wigle J, Netticadan T, Zieroth S. Comparative and Combinatorial Effects of Resveratrol and Sacubitril/Valsartan alongside Valsartan on Cardiac Remodeling and Dysfunction in MI-Induced Rats. Molecules 2021; 26:5006. [PMID: 34443591 PMCID: PMC8401506 DOI: 10.3390/molecules26165006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
The development and progression of heart failure (HF) due to myocardial infarction (MI) is a major concern even with current optimal therapy. Resveratrol is a plant polyphenol with cardioprotective properties. Sacubitril/valsartan is known to be beneficial in chronic HF patients. In this study, we investigated the comparative and combinatorial benefits of resveratrol with sacubitril/valsartan alongside an active comparator valsartan in MI-induced male Sprague Dawley rats. MI-induced and sham-operated animals received vehicle, resveratrol, sacubitril/valsartan, valsartan alone or sacubitril/valsartan + resveratrol for 8 weeks. Echocardiography was performed at the endpoint to assess cardiac structure and function. Cardiac oxidative stress, inflammation, fibrosis, brain natriuretic peptide (BNP), creatinine and neutrophil gelatinase associated lipocalin were measured. Treatment with resveratrol, sacubitril/valsartan, valsartan and sacubitril/valsartan + resveratrol significantly prevented left ventricular (LV) dilatation and improved LV ejection fraction in MI-induced rats. All treatments also significantly reduced myocardial tissue oxidative stress, inflammation and fibrosis, as well as BNP. Treatment with the combination of sacubitril/valsartan and resveratrol did not show additive effects. In conclusion, resveratrol, sacubitril/valsartan, and valsartan significantly prevented cardiac remodeling and dysfunction in MI-induced rats. The reduction in cardiac remodeling and dysfunction in MI-induced rats was mediated by a reduction in cardiac oxidative stress, inflammation and fibrosis.
Collapse
Affiliation(s)
- Pema Raj
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (P.R.); (M.P.)
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB R2H 2A6, Canada; (K.S.); (L.Y.)
- Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada
| | - Karen Sayfee
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB R2H 2A6, Canada; (K.S.); (L.Y.)
| | - Mihir Parikh
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (P.R.); (M.P.)
| | - Liping Yu
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB R2H 2A6, Canada; (K.S.); (L.Y.)
| | - Jeffrey Wigle
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E 0J9, Canada;
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada
| | - Thomas Netticadan
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (P.R.); (M.P.)
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB R2H 2A6, Canada; (K.S.); (L.Y.)
- Agriculture and Agri-Food Canada, Winnipeg, MB R3T 2M9, Canada
| | - Shelley Zieroth
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; (P.R.); (M.P.)
- Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| |
Collapse
|
16
|
Dauw J, Martens P, Deferm S, Bertrand P, Nijst P, Hermans L, Van den Bergh M, Housen I, Hijjit A, Warnants M, Cottens D, Ferdinande B, Vrolix M, Dens J, Ameloot K, Dupont M, Mullens W. Left ventricular function recovery after ST-elevation myocardial infarction: correlates and outcomes. Clin Res Cardiol 2021; 110:1504-1515. [PMID: 34091698 DOI: 10.1007/s00392-021-01887-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contemporary data on left ventricular function (LVF) recovery in patients with left ventricular dysfunction after ST-elevation myocardial infarction (STEMI) are scarce and to date, no comparison has been made with patients with a baseline normal LVF. This study examined predictors of LVF recovery and its relation to outcomes in STEMI. METHODS Patients presenting with STEMI between January 2010 and December 2016 were categorized in three groups after 3 months according to left ventricular ejection fraction (EF): (i) baseline normal LVF (EF ≥ 50% at baseline); (ii) recovered LVF (EF < 50% at baseline and ≥ 50% after 3 months); and (iii) reduced LVF (EF < 50% at baseline and after 3 months). Heart failure hospitalization, all-cause mortality and cardiovascular mortality were compared between the three groups. RESULTS Of 577 patients, 341 (59%) patients had a baseline normal LVF, 112 (19%) had a recovered LVF and 124 (22%) had a reduced LVF. Independent correlates of LVF recovery were higher baseline EF, lower peak troponin and cardiac arrest. After median 5.8 years, there was no difference in outcomes between patients with LVF recovery and baseline normal LVF. In contrast, even after multivariate adjustment, patients with persistently reduced LVF had a higher risk for heart failure hospitalization (HR 5.00; 95% CI 2.17-11.46) and all-cause mortality (HR 1.87; 95% CI 1.11-3.16). CONCLUSION In contemporary treated STEMI patients, prognosis is significantly worse in those with a persistently reduced LVF after 3 months, compared with patients with a baseline normal LVF and those with LVF recovery.
Collapse
Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. .,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium.
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Philippe Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Lowie Hermans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mats Van den Bergh
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Isabel Housen
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Amin Hijjit
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Maarten Warnants
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, LCRC, UHasselt, Diepenbeek, Belgium
| |
Collapse
|
17
|
Wheeler C, De Puy F, Schatz R. Novel intracoronary supersaturated oxygen treatment for anterior myocardial infarction. Future Cardiol 2021; 17:847-853. [PMID: 33448870 DOI: 10.2217/fca-2020-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary percutaneous coronary intervention (PCI) is now the recommended reperfusion technique for patients with acute ST-segment elevation myocardial infarction. However, despite early reperfusion in the majority of patients, PCI does not achieve effective myocardial reperfusion in a significant proportion of patients due to the prevalence of coronary microvascular obstruction. The amount of infarcted myocardium has been considered to be a reliable indicator of major adverse cardiovascular events and resultant adverse left ventricular remodeling. The purpose of this paper is to review the clinical benefits of supersaturated oxygen therapy following PCI for ST-segment elevation myocardial infarction.
Collapse
Affiliation(s)
- Carmen Wheeler
- Interventional Cardiology, Clinical Research, John R Anderson Medical Pavilion, 9898, Genesee Avenue La Jolla, CA 92037, USA
| | - Federico De Puy
- Interventional Cardiology, Scripps Clinic, John R Anderson Medical Pavilion, 9898, Genesee Avenue La Jolla, CA 92037, USA
| | - Richard Schatz
- Interventional Cardiology, Scripps Clinic, John R Anderson Medical Pavilion, 9898, Genesee Avenue La Jolla, CA 92037, USA
| |
Collapse
|
18
|
Matsushita K, Marchandot B, Carmona A, Curtiaud A, El Idrissi A, Trimaille A, Kibler M, Cardi T, Heger J, Hess S, Reydel A, Jesel L, Ohlmann P, Morel O. Increased susceptibility to SARS-CoV-2 infection in patients with reduced left ventricular ejection fraction. ESC Heart Fail 2020; 8:380-389. [PMID: 33205916 PMCID: PMC7753539 DOI: 10.1002/ehf2.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Cardiovascular disease has been recognized as a major determinant of coronavirus disease 2019 (COVID‐19) vulnerability and severity. Angiotensin‐converting enzyme (ACE) 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and is up‐regulated in patients with heart failure. We sought to examine the potential association between reduced left ventricular ejection fraction (LVEF) and the susceptibility to SARS‐CoV‐2 infection. Methods and results Of the 1162 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention between February 2014 and October 2018, we enrolled 889 patients with available clinical follow‐up data. Follow‐up was conducted by telephone interviews 1 month after the start of the French lockdown which began on 17 March 2020. Patients were divided into two groups according to LVEF <40% (reduced LVEF) (n = 91) or ≥40% (moderately reduced + preserved LVEF) (n = 798). The incidence of COVID‐19‐related hospitalization or death was significantly higher in the reduced LVEF group as compared with the moderately reduced + preserved LVEF group (9% vs. 1%, P < 0.001). No association was found between discontinuation of ACE‐inhibitor or angiotensin‐receptor blockers and COVID‐19 test positivity. By multivariate logistic regression analysis, reduced LVEF was an independent predictor of COVID‐19 hospitalization or death (odds ratio: 6.91, 95% confidence interval: 2.60 to 18.35, P < 0.001). Conclusions In a large cohort of patients with previous ACS, reduced LVEF was associated with increased susceptibility to COVID‐19. Aggressive COVID‐19 testing and therapeutic strategies may be considered for patient with impaired heart function.
Collapse
Affiliation(s)
- Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Adrien Carmona
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Anais Curtiaud
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Anis El Idrissi
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Antonin Trimaille
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Marion Kibler
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Joe Heger
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Sebastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Antje Reydel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| |
Collapse
|
19
|
Wu WY, Biery DW, Singh A, Divakaran S, Berman AN, Ayuba G, DeFilippis EM, Nasir K, Januzzi JL, Di Carli MF, Bhatt DL, Blankstein R. Recovery of Left Ventricular Systolic Function and Clinical Outcomes in Young Adults With Myocardial Infarction. J Am Coll Cardiol 2020; 75:2804-2815. [PMID: 32498808 PMCID: PMC7392115 DOI: 10.1016/j.jacc.2020.03.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (EF) recovery is associated with better long-term outcomes after myocardial infarction (MI). However, the association between long-term outcomes and EF recovery among young MI patients has not been investigated. OBJECTIVES This study sought to evaluate the prevalence of left ventricular systolic dysfunction among patients who experience their first MI at a young age and to compare outcomes between those who recovered their EF versus those who did not. METHODS The YOUNG-MI registry is a retrospective cohort study of patients who experienced an MI at ≤50 years of age. EF at the time of MI and within 180 days post-MI were determined from all available medical records. The primary outcomes were all-cause and cardiovascular mortality. RESULTS There were 1,724 patients with baseline EF data: 503 (29%) had EF <50%, whereas 1,221 (71%) had a normal baseline EF. Patients with lower EF were more likely to have experienced ST-segment elevation MI, have higher troponin values, and have more severe angiographic coronary artery disease. Among patients with abnormal baseline EF, information on follow-up EF was available for 216, of whom 90 (42%) recovered their EF to ≥50%. Patients who experienced EF recovery had less severe angiographic disease, lower alcohol use, and a lower burden of comorbidities. Over a median follow-up of 11.1 years, EF recovery was associated with an ∼8-fold reduction in all-cause mortality (adjusted hazard ratio: 0.12; p = 0.001) and a ∼10-fold reduction in cardiovascular mortality (adjusted hazard ratio: 0.10; p = 0.025). CONCLUSIONS Nearly one-third of young patients presented with left ventricular dysfunction post-MI. Among them, EF recovery occurred in more than 40% and was independently associated with a substantial decrease in all-cause and cardiovascular mortality.
Collapse
Affiliation(s)
- Wanda Y Wu
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - David W Biery
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Sanjay Divakaran
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam N Berman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gloria Ayuba
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ersilia M DeFilippis
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcelo F Di Carli
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBHATTMD
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
20
|
Alzuhairi KS, Lønborg J, Ahtarovski KA, Nepper-Christensen L, Kyhl K, Lassen JF, Sørensen R, Joshi F, Ghotbi AA, Schoos M, Goransson C, Bertelsen L, Helqvist S, Holmvang L, Jørgensen E, Pedersen F, Tilsted HH, Høfsten D, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T. Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction: A DANAMI-3 sub-study. Int J Cardiol 2020; 301:215-219. [PMID: 31748187 DOI: 10.1016/j.ijcard.2019.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/01/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
AIMS To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). METHODS AND RESULTS A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47-36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07-50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27-47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83-328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. CONCLUSION Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization.
Collapse
Affiliation(s)
| | - Jacob Lønborg
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | | | | | - Kasper Kyhl
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Jens F Lassen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Rikke Sørensen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Francis Joshi
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Adam Ali Ghotbi
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Mikkel Schoos
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | | | - Litten Bertelsen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Steffen Helqvist
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Lene Holmvang
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Erik Jørgensen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Frants Pedersen
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Hans-Henrik Tilsted
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Dan Høfsten
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Lars Køber
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Niels Vejlstrup
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Thomas Engstrøm
- The Heart Centre at Rigshospitalet (Copenhagen University Hospital), Denmark; University of Lund, Sweden.
| |
Collapse
|
21
|
Ohashi J, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Nanba-Sato H, Shibata K, Sasaki W, Ikeda T, Wada H, Momomura SI, Fujita H. Determinants of Improvement of Mid-term Ejection Fraction in Patients with Acute Myocardial Infarction. Int Heart J 2019; 60:1245-1252. [PMID: 31735776 DOI: 10.1536/ihj.19-126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Persistent severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI) is associated with increased morbidity and mortality, whereas mid-term recovery of LV systolic function after AMI is associated with better long-term outcomes. The purpose of this study was to investigate the determinants of mid-term improvement of LV ejection fraction (EF) in AMI patients. We included 210 AMI patients who had modified Simpson EF both at the index admission and mid-term follow up. The difference of EF between the index admission and mid-term follow-up was calculated in all study patients. The EF improvement group was defined as mid-term ≥ 10% EF increase compared with the index admission EF. Of 210 AMI patients, 46 (21.9%) were allocated to the EF improvement group and 164 (78.1%) to the non-EF improvement group. Brain natriuretic peptide (BNP) at the timing of admission was significantly greater in the EF improvement group (735.8 ± 1077.6 pg/mL) than in the non-EF improvement group (239.0 ± 419.8 pg/mL) (P < 0.001). Multivariate logistic regression analysis revealed that log10 BNP at the timing of admission (OR 3.36, 95% CI 1.69-6.66, P < 0.001) and left main trunk-left anterior descending artery (LM-LAD) as the infarct-related artery (OR 3.34, 95% CI 1.59-7.02, P = 0.001) were significantly associated with EF improvement. In conclusion, elevated BNP at the timing of admission and LM-LAD as the infarct-related artery were significantly associated with mid-term LVEF recovery. Our results support aggressive acute treatment for those severe AMI, because the possibility of mid-term LVEF recovery is greater compared with other AMI.
Collapse
Affiliation(s)
- Jumpei Ohashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hitomi Nanba-Sato
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kaho Shibata
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Wataru Sasaki
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tomoya Ikeda
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| |
Collapse
|
22
|
Muhrbeck J, Gunyeli E, Andersson E, Alam M, Frykman V, Sjoblom J. Does stress echocardiography add incremental value to baseline ejection fraction for the early identification of candidates for implantable defibrillators? Open Heart 2019; 6:e001053. [PMID: 31363415 PMCID: PMC6629390 DOI: 10.1136/openhrt-2019-001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/10/2019] [Accepted: 06/13/2019] [Indexed: 11/08/2022] Open
Abstract
Objective A reduction in left ventricular ejection fraction (EF) remains the strongest indicator of increased risk of sudden cardiac death after an acute myocardial infarction (AMI). Guidelines recommend that patients with an EF ≤35%, 6–12 weeks after AMI should be considered for implantable cardioverter defibrillator (ICD) therapy. Stress echocardiography is a safe method to detect viability in a stunned myocardium. The purpose of this study was to investigate if stress echocardiography early after AMI could identify ICD candidates before discharge. Methods Ninety-six patients with EF ≤40% early after AMI were prospectively included in a cohort study, and investigated by baseline and stress echocardiography before discharge. Follow-up echocardiography was performed after 3 months. EF, mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (PSV) were determined for each examination. Results There were 80 (83%) patients who completed the baseline, stress and follow-up echocardiography. Among them there were 32 (40%) patients who met the ICD criteria of EF ≤35% at 3 months. For these patients, EF, MAPSE and PSV were significantly lower than for those patients who recovered. The area under the receiver operating characteristic curve (AUC) was 85% (95% CI 0.74 to 0.94) for baseline EF to predict non-recovery. None of the other variables had a higher AUC. Conclusion Patients who met the ICD criteria of EF ≤35% at 3 months after myocardial infarction had lower EF, MAPSE and PSV on baseline and stress echocardiograph before discharge. Stress echocardiography did not add additional value in predicting non-recovery.
Collapse
Affiliation(s)
- Josephine Muhrbeck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Elif Gunyeli
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eva Andersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mahbubul Alam
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Sjoblom
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Warriner D, Al-Matok M. Primary care management following an acute myocardial infarction. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/indn.2019.4.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- David Warriner
- Cardiology Registrar, Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS
| | - Mohanned Al-Matok
- Clinical Fellow, Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS
| |
Collapse
|
24
|
Abou R, Leung M, Goedemans L, Hoogslag GE, Schalij MJ, Marsan NA, Bax JJ, Delgado V. Effect of Guideline-Based Therapy on Left Ventricular Systolic Function Recovery After ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 122:1591-1597. [PMID: 30213383 DOI: 10.1016/j.amjcard.2018.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022]
Abstract
Little is known about the proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention, who have reduced left ventricular ejection fraction (LVEF) within 48 hours (baseline) of admission and exhibit LVEF recovery under optimal guideline-based medical treatment. Therefore, the present study evaluates the evolution of LVEF in patients after STEMI and under guideline-based medical therapy. In 2,853 STEMI patients treated with primary percutaneous coronary intervention, echocardiography was performed at baseline and at 6 months follow-up. Patients with previous myocardial infarction, reinfarction, coronary artery bypass grafting or incomplete echocardiographic data at 6 months follow-up were excluded. Reduced LVEF at baseline was defined as <40%. LVEF recovery was defined as LVEF >50% at 6 months follow-up. The prevalence of LVEF <40% at baseline was 13% (n = 371 patients; mean age 60 [range 33 to 88] years; 76% men). At follow-up, 31% of patients remained with a LVEF <40%, 30% showed a LVEF between 41% and 49% and in 39% of patients LVEF improved to >50%. There were no differences in usage of guideline-based medications at discharge across groups. On multivariable analysis, peak troponin T levels (odds ratio [OR] 0.895; p < 0.001), baseline LVEF (OR 1.069; p = 0.023) and absence of significant mitral regurgitation (OR 0.376; p = 0.018) were independently associated with LV recovery at follow-up. In conclusion, the prevalence of LVEF <40% is low. With optimal medical therapy, LVEF normalizes in 39% of patients. Smaller enzymatic infarct size, baseline LVEF and absence of mitral regurgitation were independently associated with LVEF recovery at follow-up.
Collapse
Affiliation(s)
- Rachid Abou
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melissa Leung
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Georgette E Hoogslag
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
25
|
Zaman S, Goldberger JJ, Kovoor P. Sudden Death Risk-Stratification in 2018-2019: The Old and the New. Heart Lung Circ 2018; 28:57-64. [PMID: 30482684 DOI: 10.1016/j.hlc.2018.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022]
Abstract
Sudden Cardiac Death (SCD) is a major public health issue, accounting for half of all cardiovascular deaths world-wide. The implantable cardioverter-defibrillator (ICD) has been solidified as the cornerstone therapy in primary prevention of SCD in ischaemic and non-ischaemic cardiomyopathy. However, what has become increasingly clear is that the left ventricular ejection fraction (LVEF) is an inadequate tool to select patients for a prophylactic ICD, despite its widespread use for this purpose. Use of LVEF alone has poor specificity for arrhythmic versus non-arrhythmic death. In addition, the vast majority of sudden deaths occur in patients with more preserved cardiac function. Alternate predictors of sudden death include electrophysiology study, non-invasive markers of electrical instability, myocardial fibrosis, genetic and bio-markers. The challenge for the future is finding a risk stratification test, or combination of tests, that adequately select patients at high risk of SCD with low competing risk of non-sudden death.
Collapse
Affiliation(s)
- Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; MonashHEART, Monash Medical Centre, Melbourne, Vic, Australia
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
26
|
Mohammad MA, Koul S, Smith JG, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Engstrøm T, Arheden H, James S, Lindahl B, Metzler B, Erlinge D. Predictive Value of High-Sensitivity Troponin T for Systolic Dysfunction and Infarct Size (Six Months) After ST-Elevation Myocardial Infarction. Am J Cardiol 2018; 122:735-743. [PMID: 30049462 DOI: 10.1016/j.amjcard.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
The association of markers of myocardial injury and dysfunction with infarct size (IS) and ejection fraction (EF) are well documented. However, limited data are available on the newer high-sensitivity troponin assays and comparison with morphologic and functional assessment with cardiac magnetic resonance imaging. We aimed to examine the associations of high-sensitivity cardiac Troponin-T (hs-cTnT), creatine kinase MB iso-enzyme (CKMB), and N-terminal pro B-type Natriuretic Peptide (NT-proBNP) to IS and EF at 6 months. Blood samples from 119 ST-segment elevation myocardial infarction patients from the Rapid Endovascular Catheter Core Cooling Combined With Cold Saline solution as an Adjunct to Percutaneous Coronary Intervention for the Treatment of Acute Myocardial Infarction trial were collected at baseline, 6, 24, and 48 hours after admission. Cardiac magnetic resonance was performed at 4 ± 2 days and 6 months. The association of biomarker levels to IS and EF was tested with Pearson's correlation coefficients and linear regression models with bootstrap resampling. The correlation coefficient of biomarker to IS was (CKMB: r = 0.71); (NT-proBNP: r = 0.55); (hs-cTnT: r = 0.80); and for EF (CKMB: r = 0.57); (NT-proBNP: r = 0.48); and (peak hs-cTnT: r = 0.68). IS and EF at 4 ± 2 days had the strongest correlations with IS and EF at 6 months respectively (IS: r = 0.84) and (EF: r = 0.74). Receiver operating characteristic of peak hs-cTnT for predicting EF ≤40% at 6 months was 0.87 compared with 0.75 for early IS. Early EF was a negative predictor of late EF <40%, 1-area under curve = 0.93. In conclusion, high-sensitivity Troponin T is a rapid, cheap, generally available tool for accurate prediction of systolic dysfunction in patients 6 months after first-time ST-segment elevation myocardial infarction.
Collapse
Affiliation(s)
- Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Marco Noc
- Center for Intensive Internal Medicine, Ljubljana, Slovenia
| | - Irene Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg-Eppendorf, Hamburg, Germany; Department of Medicine, Division of Cardiology, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark
| | - Ulf Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Engstrøm
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
| |
Collapse
|
27
|
Shehata IE, Cheng CI, Sung PH, Ammar AS, El-Sherbiny IAEM, Ghanem IGA. Predictors of myocardial functional recovery following successful reperfusion of acute ST elevation myocardial infarction. Echocardiography 2018; 35:1571-1578. [PMID: 30073720 DOI: 10.1111/echo.14106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Following acute ST elevation myocardial infarction (STEMI), restoration of large-vessel patency does not mean complete perfusion recovery. Little is known regarding the predictors of successful myocardial reperfusion for the STEMI patients undergoing pharmacologic and mechanical reperfusion strategies. AIM OF THE WORK The aim of this clinical study was to find out the predictors of myocardial functional recovery following reperfusion of acute STEMI, represented by 3-month global longitudinal strain (GLS) value assessed by speckle tracking echocardiography. MATERIAL/METHODS The study population included 400 patients presented with first acute STEMI with successful reperfusion by thrombolysis (group I) or primary percutaneous coronary intervention (PPCI) (group II). Electrocardiography (ECG) at baseline and 90 minutes after coronary reperfusion was performed with assessment of ST resolution. Basal and 3-month follow-up echocardiography was performed with assessment of ejection fraction (EF), myocardial performance index (MPI), systolic myocardial excursion (S'), and GLS. RESULTS There was nonsignificant difference between patients of both groups regarding age (P = 0.422) and gender (P = 0.272). Also, there was a nonsignificant difference between both groups regarding the risk factors of coronary artery disease like hypertension (P = 0.511), diabetes mellitus (P = 0.332), and smoking (P = 0.381). But there was significant statistical difference between both groups regarding dyslipidemia (P = 0.012). Ninety-minute ST resolution was significantly higher in PPCI group (P = 0.042). Moreover, PPCI group had significant improvement of EF (P = 0.013) during follow-up, and highly significant improvement of MPI, S' and GLS (P ˂ 0.001) compared to the basal echocardiographic study. The percentage of change (∆) of each of the echocardiographic parameter was compared between both groups and revealed statistically significant improvement regarding EF, highly significant improvement of MPI, S' and GLS in favor of PPCI arm (group II). Multivariate regression analysis demonstrated that pain to reperfusion time, MI territory, ST resolution, and basal GLS value are the most important predictors for LV functional recovery. CONCLUSION The study found pain to reperfusion time, MI territory, ST resolution, basal GLS value are the most important predictors of myocardial functional recovery. Regular follow-up with echocardiography for STEMI patients with different reperfusion strategies has informative impact on long-term clinical outcome. Also the study confirmed that PPCI is better than thrombolysis not only in restoring epicardial coronary flow but also in restoring microvascular and tissue perfusion assuring better myocardial functional recovery and better long-term clinical outcomes.
Collapse
Affiliation(s)
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ahmed S Ammar
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Islam Ghanem Ahmed Ghanem
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
28
|
Randomized placebo controlled trial evaluating the safety and efficacy of single low-dose intracoronary insulin-like growth factor following percutaneous coronary intervention in acute myocardial infarction (RESUS-AMI). Am Heart J 2018; 200:110-117. [PMID: 29898838 DOI: 10.1016/j.ahj.2018.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Residual and significant postinfarction left ventricular (LV) dysfunction, despite technically successful percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), remains an important clinical issue. In preclinical models, low-dose insulin-like growth factor 1 (IGF1) has potent cytoprotective and positive cardiac remodeling effects. We studied the safety and efficacy of immediate post-PCI low-dose intracoronary IGF1 infusion in STEMI patients. METHODS Using a double-blind, placebo-controlled, multidose study design, we randomized 47 STEMI patients with significantly reduced (≤40%) LV ejection fraction (LVEF) after successful PCI to single intracoronary infusion of placebo (n = 15), 1.5 ng IGF1 (n = 16), or 15 ng IGF1 (n = 16). All received optimal medical therapy. Safety end points were freedom from hypoglycemia, hypotension, or significant arrhythmias within 1 hour of therapy. The primary efficacy end point was LVEF, and secondary end points were LV volumes, mass, stroke volume, and infarct size at 2-month follow-up, all assessed by magnetic resonance imaging. Treatment effects were estimated by analysis of covariance adjusted for baseline (24 hours) outcome. RESULTS No significant differences in safety end points occurred between treatment groups out to 30 days (χ2 test, P value = .77). There were no statistically significant differences in baseline (24 hours post STEMI) clinical characteristics or LVEF among groups. LVEF at 2 months, compared to baseline, increased in all groups, with no statistically significant differences related to treatment assignment. However, compared with placebo or 1.5 ng IGF1, treatment with 15 ng IGF1 was associated with a significant improvement in indexed LV end-diastolic volume (P = .018), LV mass (P = .004), and stroke volume (P = .016). Late gadolinium enhancement (±SD) at 2 months was lower in 15 ng IGF1 (34.5 ± 29.6 g) compared to placebo (49.1 ± 19.3 g) or 1.5 ng IGF1 (47.4 ± 22.4 g) treated patients, although the result was not statistically significant (P = .095). CONCLUSIONS In this pilot trial, low-dose IGF1, given after optimal mechanical reperfusion in STEMI, is safe but does not improve LVEF. However, there is a signal for a dose-dependent benefit on post-MI remodeling that may warrant further study.
Collapse
|
29
|
Vanezis AP, Arnold JR, Rodrigo G, Lai FY, Debiec R, Nazir S, Khan JN, Ng LL, Chitkara K, Coghlan JG, Hetherington SL, McCann GP, Samani NJ. Daily remote ischaemic conditioning following acute myocardial infarction: a randomised controlled trial. Heart 2018; 104:1955-1962. [PMID: 29748420 PMCID: PMC6252375 DOI: 10.1136/heartjnl-2018-313091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Remote ischaemic conditioning (rIC) is a cardioprotective tool which has shown promise in preclinical and clinical trials in the context of acute ischaemia. Repeated rIC post myocardial infarction may provide additional benefits which have not previously been tested clinically. METHODS The trial assessed the role of daily rIC in enhancing left ventricular ejection fraction (LVEF) recovery in patients with impaired LVEF (<45%) after ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (P-PCI). Patients were recruited from four UK hospitals and randomised to receive either 4 weeks of daily rIC or sham conditioning using the autoRIC Device (CellAegis) starting on day 3 post P-PCI. The primary endpoint was the improvement in LVEF over 4 months assessed by cardiac MRI (CMR). Seventy-three patients (38 cases, 35 controls) completed the study. RESULTS The treatment and control groups were well matched at baseline including for mean LVEF (42.8% vs 44.3% respectively, p=0.952). There was no difference in the improvement in LVEF over 4 months between the treatment and control groups (4.8%±7.8% vs 4.6%±5.9% respectively, p=0.924). No differences were seen in the secondary outcome measures including changes in infarct size and left ventricular end-diastolic and systolic volumes, major adverse cardiac and cerebral event, mean Kansas City Cardiomyopathy Questionnaire score and change in N-terminal pro-brain natriuretic peptide levels. CONCLUSIONS Daily rIC starting on day 3 and continued for 4 weeks following successful P-PCI for STEMI did not improve LVEF as assessed by CMR after 4 months when compared with a matched control group. TRIAL REGISTRATION NUMBER NCT0166461.
Collapse
Affiliation(s)
- Andrew Peter Vanezis
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Jayanth Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Glenn Rodrigo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Radek Debiec
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Sheraz Nazir
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Jamal Nasir Khan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | | | | | | | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| |
Collapse
|
30
|
Chew DS, Heikki H, Schmidt G, Kavanagh KM, Dommasch M, Bloch Thomsen PE, Sinnecker D, Raatikainen P, Exner DV. Change in Left Ventricular Ejection Fraction Following First Myocardial Infarction and Outcome. JACC Clin Electrophysiol 2018; 4:672-682. [DOI: 10.1016/j.jacep.2017.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 11/28/2022]
|
31
|
Chew DS, Wilton SB, Kavanagh K, Southern DA, Tan-Mesiatowsky LE, Exner DV. Left ventricular ejection fraction reassessment post-myocardial infarction: Current clinical practice and determinants of adverse remodeling. Am Heart J 2018; 198:91-96. [PMID: 29653653 DOI: 10.1016/j.ahj.2017.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Left ventricular (LV) dysfunction may be sustained or aggravated during the convalescent months following an acute myocardial infarction (MI) and is difficult to predict. We sought to determine current practice patterns of LV ejection fraction (LVEF) reassessment during the months following MI and evaluate the predictors and clinical significance of LVEF change in a prospective post-MI patient cohort. METHODS Patients with an acute MI between June 2010 and August 2014 were identified using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry. Patients with initial LV dysfunction (LVEF <40% with first MI or <45% with multiple MI events) underwent a protocol-driven repeat LVEF assessment in follow-up if routine LVEF reassessment was not performed. RESULTS Of 5,964 MI patients, follow-up LVEF assessments were attained for 442 of the 695 patients who had significant LV dysfunction. A sizable proportion (25%) had either no increase or a decline in LVEF. Adverse remodeling was associated with an anterior MI location, a greater peak serum troponin T, and a higher baseline LVEF at time of MI. Adverse LV remodeling conferred a 3-fold risk of death (hazard ratio 3.0, 95% CI 1.6-5.7, P=.001) adjusted for baseline LVEF, anterior MI location, and medication use. CONCLUSIONS Current practice of LVEF reassessment during the convalescent months post-MI is suboptimal despite a sizeable proportion of patients that undergo adverse LV remodeling. Targeting processes affecting low rates of LVEF reassessment may reduce missed care opportunities and ensure that patients consistently receive appropriate evidence-based and guideline-recommended care.
Collapse
Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Katherine Kavanagh
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
32
|
Serrao GW, Lansky AJ, Mehran R, Stone GW. Predictors of Left Ventricular Ejection Fraction Improvement After Primary Stenting in ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol 2018; 121:678-683. [PMID: 29394998 DOI: 10.1016/j.amjcard.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
The predictors of improvement in left ventricular ejection fraction (LVEF) after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) are poorly understood. We sought to determine the prevalence and clinical and angiographic predictors of LVEF improvement after primary PCI in STEMI. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction trial, 3,602 patients presenting with STEMI were randomized to heparin + a glycoprotein IIb/IIIa inhibitor versus bivalirudin. Routine 13-month angiographic follow-up was performed in a prespecified substudy of 656 stented patients. The median [25%, 75%] change in LVEF from baseline to 13 months was +2.4% [-5.9%, 11.8%]; LVEF increased or remained unchanged in 379 patients (57.8%; median Δ +9.8% [4.3%, 16.4%]) and fell in 277 patients (42.2%; median Δ -7.0% [-11.8%, -3.6%]). Independent predictors of LVEF improvement were female gender (p = 0.002), lower baseline LVEF (p <0.0001), Thrombolysis in Myocardial Infarction 3 flow after PCI (p = 0.03), shorter lesion length (p = 0.04), and lower post-PCI peak MB isoenzyme of creatine kinase (p <0.0001). In conclusion, in the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction trial, although LVEF improved during follow-up after primary PCI in more than half of patients, left ventricular function worsened over time in a substantial proportion, the occurrence of which may be predicted by clinical, angiographic, and laboratory variables.
Collapse
|
33
|
Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag 2018; 9:3035-3049. [PMID: 32477797 PMCID: PMC7252689 DOI: 10.19102/icrm.2018.090201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/02/2017] [Indexed: 01/20/2023] Open
Abstract
Despite advances in the diagnosis and treatment of acute coronary syndromes and an overall improvement in outcomes, mortality after myocardial infarction (MI) remains high. Sudden death, which is most frequently due to ventricular tachycardia or ventricular fibrillation, is the cause of death in 25% to 50% of patients with prior MI, and therefore represents an important public health problem. Use of the implantable cardioverter-defibrillator (ICD), which is the primary method of reducing the chance of arrhythmic sudden death after MI, is costly to the medical system and is associated with procedural and long-term risks. Additionally, assessment of left ventricular ejection fraction (LVEF), which is the primary method of assessing a patient's post-MI sudden death risk and appropriateness for ICD implantation, lacks both sensitivity and specificity for sudden death, and may not be the optimal way to select the subgroup of post-MI patients who are most likely to benefit from ICD implantation. To optimally utilize ICDs, it is therefore critical to develop and prospectively validate sudden death risk stratification methods beyond measuring LVEF. A variety of tests that assess left ventricular systolic function/morphology, potential triggers for ventricular arrhythmias, ventricular conduction/repolarization, and autonomic tone have been proposed as sudden death risk stratification tools. Multivariable models have also been developed to assess the competing risks of arrhythmic and non-arrhythmic death so that ICDs can be utilized more effectively. This manuscript will review the epidemiology of sudden death after MI, and will discuss the current state of sudden death risk stratification in this population.
Collapse
Affiliation(s)
- An H. Bui
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan W. Waks
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
34
|
Lamblin N, Meurice T, Tricot O, Lemesle G, Deneve M, de Groote P, Bauters C. Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients. Arch Cardiovasc Dis 2016; 110:35-41. [PMID: 27591820 DOI: 10.1016/j.acvd.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD). AIMS The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD. METHODS We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly. RESULTS The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively). CONCLUSIONS In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.
Collapse
Affiliation(s)
- Nicolas Lamblin
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Olivier Tricot
- Centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Gilles Lemesle
- CHRU de Lille, 59037 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Pascal de Groote
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France
| | - Christophe Bauters
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
| |
Collapse
|
35
|
Stolfo D, Cinquetti M, Merlo M, Santangelo S, Barbati G, Alonge M, Vitrella G, Rakar S, Salvi A, Perkan A, Sinagra G. ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis. Int J Cardiol 2016; 215:340-5. [DOI: 10.1016/j.ijcard.2016.04.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 10/22/2022]
|
36
|
|
37
|
Johnson BK, Garberich RF, Henry TD, Katsiyiannis WT, Sengupta J, Kalra A, Hauser RG, Lardy ME, Newell MC. Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system. Heart Rhythm 2015; 13:538-46. [PMID: 26576706 DOI: 10.1016/j.hrthm.2015.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies have shown mortality benefit for implantable cardioverter-defibrillators (ICDs) in ST-elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF), but contemporary eligibility and appropriate utilization of ICDs is unknown. OBJECTIVE The purpose of this study was to determine the contemporary eligibility and appropriate utilization of ICDs post-STEMI. METHODS Using the prospective Minneapolis Heart Institute regional STEMI registry, LVEF before discharge and at follow-up were stratified into 3 groups: normal (LVEF ≥50%), mildly reduced (LVEF 35%-49%), and severely reduced (LVEF <35%). RESULTS From March 2003 to June 2012, 3626 patients were treated. Patients with in-hospital death (n = 187), ICD in place (n = 21), negative cardiac biomarkers (n = 337), and undocumented in-hospital LVEF (n = 9) were excluded, leaving 3072 patients in the final analysis, including 1833 (59.7%) with LVEF ≥50%, 875 (28.5%) with LVEF between 35% and 49%, and 364 (11.8%) with LVEF <35% before hospital discharge. Overall, 1029 patients (33.5%) underwent follow-up echocardiography ≥40 days post-STEMI, including 140 of the 364 patients (38.5%) discharged with LVEF <35%. In total, 73 patients (7.1%) with follow-up echocardiography ≥40 days post-STEMI met criteria for an ICD (68 LVEF ≤30%, 5 LVEF 30%-35%, and New York Heart Association class II or greater). Only 26 of these patients (35.6%) underwent ICD placement within 1 year post-STEMI. Overall, only 10% to 15% of potentially eligible patients had an ICD implemented. CONCLUSION Rates of ICD implantation in appropriate STEMI patients after 40 days are low. Strategies are needed to identify and expand access to these high-risk patients.
Collapse
Affiliation(s)
- Benjamin K Johnson
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Hennepin County Medical Center, Minneapolis, Minnesota
| | - Ross F Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California
| | - William T Katsiyiannis
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Sengupta
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ankur Kalra
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Robert G Hauser
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Meghan E Lardy
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Marc C Newell
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
| |
Collapse
|
38
|
Phan TT, Khan S, Mahmood MM, Mani S, Wadehra V, de Belder M, Thornley A, James S, Linker NJ, Turley AJ. The 7-year teesside experience of primary prevention ICD indications following primary PCI (PPCI) and the potential impact of a change in NICE guidance. Open Heart 2015; 2:e000153. [PMID: 25932332 PMCID: PMC4410140 DOI: 10.1136/openhrt-2014-000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The recovery of LV function in patients with severe LV impairment in the acute phase following primary percutaneous coronary intervention (PPCI) is not well established. The indication for a primary prevention ICD post-STEMI is dependent on which screening guidance, NICE or ESC, is followed. The potential impact of the new NICE guidance is estimated. METHODS We performed a retrospective analysis of all patients presenting with a STEMI over a 7-year period (2005-2012) treated with PPCI to determine in-hospital mortality, LV function at index presentation, at 3 months and the predicted primary prevention ICD implantation rate using NICE (TA095) and ESC 2006 guidelines. Predicted implant rates using the new NICE guidance (TA314) and actual implantation rates were also assessed. RESULTS 3902 patients with a mean age of 65±13 years underwent PPCI. Of those patients surviving until discharge, 332 (10%) had LVEF ≤35%. 254 of 332 patients (76%) with a severely impaired ventricle were followed up at participating centres. 210 of 254 (83%) patients had a repeat echocardiogram within 3 months post-MI; among these patients, 89 (42%) remained to have LVEF ≤35%. The number of patients fulfilling NICE and ESC criteria for primary prevention ICD implantation was 14 (16%) and 84 (94%), respectively. The actual number of patients receiving an ICD was 17 (19%). The number of patients fulfilling the new NICE (TA314) guidance was 84 (94%). CONCLUSIONS A small proportion of patients with STEMIs undergoing PPCI have a severely impaired LV systolic function. A large proportion of these patients will have improved LV systolic function at 3 months. There is a five-fold difference in the predicted ICD implantation rates depending on which guidance is followed-NICE versus ESC. The potential impact of the new NICE (TA314) guidance on ICD implantation will be a significant increase in ICD implantation rates.
Collapse
Affiliation(s)
| | - Saima Khan
- James Cook University Hospital , Middlesbrough , UK
| | | | - Sudha Mani
- Darlington Memorial Hospital , County Durham , UK
| | - Vineet Wadehra
- University Hospital of North Tees , Stockton-on-Tees , UK
| | | | | | - Simon James
- James Cook University Hospital , Middlesbrough , UK
| | | | | |
Collapse
|
39
|
Sarathy K, Nagaraja V, Kapur A, Szirt R, Raval J, Eslick GD, Burgess D, Denniss AR. Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: a meta-analysis of randomised trials. Heart Lung Circ 2014; 24:327-34. [PMID: 25547531 DOI: 10.1016/j.hlc.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 09/10/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In acute ST-segment elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. The concurrent treatment of non-infarct vessels with significant stenoses during initial angiography remains an area of controversy. METHODS A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library, Google Scholar, Science Direct, and Web of Science. Original data were abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). RESULTS Only four randomised trials comprising 775 patients met full criteria for analysis. The incidence of non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was lower in the multivessel revascularisation cohort. Death from cardiac causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336, 95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26% vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the multivessel revascularisation cohort. The Median Contrast Volume and Procedure Length were similar in both cohorts. CONCLUSIONS In patients with acute STEMI who undergo primary PCI, a strategy of treatment of significant non-infarct stenosis (preventive PCI) in addition to the culprit lesion responsible for infarction may result in improved cardiovascular outcomes and reduced overall mortality; however there is insufficient data to fully validate this from currently published literature.
Collapse
Affiliation(s)
- Kiran Sarathy
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Vinayak Nagaraja
- Prince of Wales Hospital, University of New South Wales, Sydney; The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney
| | - Amit Kapur
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Richard Szirt
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Jwalant Raval
- Department of Cardiology, Blacktown Hospital, Sydney.
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney
| | - David Burgess
- Department of Cardiology, Blacktown Hospital, Sydney
| | | |
Collapse
|
40
|
Zaman S, Kovoor P. Sudden cardiac death early after myocardial infarction: pathogenesis, risk stratification, and primary prevention. Circulation 2014; 129:2426-35. [PMID: 24914016 DOI: 10.1161/circulationaha.113.007497] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sarah Zaman
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia.
| |
Collapse
|
41
|
Zaman S, Narayan A, Thiagalingam A, Sivagangabalan G, Thomas S, Ross DL, Kovoor P. What is the optimal left ventricular ejection fraction cut-off for risk stratification for primary prevention of sudden cardiac death early after myocardial infarction? Europace 2014; 16:1315-21. [DOI: 10.1093/europace/euu026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
42
|
Oh PC, Choi IS, Ahn T, Moon J, Park Y, Seo JG, Suh SY, Ahn Y, Jeong MH. Predictors of recovery of left ventricular systolic dysfunction after acute myocardial infarction: from the korean acute myocardial infarction registry and korean myocardial infarction registry. Korean Circ J 2013; 43:527-33. [PMID: 24044011 PMCID: PMC3772297 DOI: 10.4070/kcj.2013.43.8.527] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/24/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives We investigated the predictors of the recovery of depressed left ventricular ejection fraction (LVEF) in patients with moderate or severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (MI). Subjects and Methods We analyzed 1307 patients, who had moderately or severely depressed LVEF (<45%) on echocardiography soon after acute MI and who underwent a follow-up echocardiography, among 27369 patients from the Korea Working Group on the Myocardial Infarction Registry. Patients were categorized into two groups according to recovery of LVEF: group I with consistently depressed LVEF (<45%) at the follow-up echocardiography and group II with a recovery of LVEF (≥45%). Results Recovery of LV systolic dysfunction was observed in 51% of the subjects (group II, n=663; ΔLVEF, 16.2±9.3%), whereas there was no recovery in the remaining subjects (group I, n=644; ΔLVEF, 0.6±7.1%). In the multivariate analysis, independent predictors of recovery of depressed LVEF were as follows {odds ratio (OR) [95% confidence interval (CI)]}: moderate systolic dysfunction {LVEF ≥30% and <45%; 1.73 (1.12-2.67)}, Killip class I-II {1.52 (1.06-2.18)}, no need for diuretics {1.59 (1.19-2.12)}, non-ST-segment elevation MI {1.55 (1.12-2.16)}, lower peak troponin I level {<24 ng/mL, median value; 1.55 (1.16-2.07)}, single-vessel disease {1.53 (1.13-2.06)}, and non-left anterior descending (LAD) culprit lesion {1.50 (1.09-2.06)}. In addition, the use of statin was independently associated with a recovery of LV systolic dysfunction {OR (95% CI), 1.46 (1.07-2.00)}. Conclusion Future contractile recovery of LV systolic dysfunction following acute MI was significantly related with less severe heart failure at the time of presentation, a smaller extent of myonecrosis, or non-LAD culprit lesions rather than LAD lesions.
Collapse
Affiliation(s)
- Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ng S, Ottervanger JP, van 't Hof AW, de Boer MJ, Reiffers S, Dambrink JHE, Hoorntje JC, Gosselink AM, Suryapranata H. Impact of ischemic time on post-infarction left ventricular function in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiol 2013; 165:523-7. [DOI: 10.1016/j.ijcard.2011.09.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 08/16/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
|
44
|
Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Am Heart J 2011; 162:663-70. [PMID: 21982658 DOI: 10.1016/j.ahj.2011.08.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 08/03/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Congestive heart failure (CHF) is a major source of morbidity, mortality, and health-care resource consumption. However, the incidence of symptomatic CHF after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has rarely been fully reported. We therefore examined the early and late incidence, predictors, and implications of CHF in the large-scale, prospective, randomized HORIZONS-AMI trial. METHODS AND RESULTS New York Heart Association (NYHA) functional classification was prospectively collected from patient-level data at baseline, 30 days, 6 months, and at 1 and 2 years from 3,343 patients with STEMI undergoing PCI at 123 centers in 11 countries. The baseline incidence of CHF (before the index STEMI) was 2.6%, increasing to 4.6% 1 month after primary PCI (P < .0001), 4.7% at 1 year, and 5.1% at 2 years. The incidence of NYHA class III/IV symptoms was 0.4% at baseline and 0.8% at 2 years (P = .03). CHF at 1 year was associated with diabetes (P < .0001), dyslipidemia (P = .009), previous MI (P < .0001), previous revascularization (P = .01), anterior STEMI (P = .02), and baseline TIMI grade 0 flow (P = .01) but not procedural anticoagulation with bivalirudin versus heparin + GPIIb/IIIa inhibitors (P = .93) or use of drug-eluting versus bare metal stents (P = .66). Among patients in whom CHF was not present at baseline but developed after PCI, the rate of all-cause mortality was significantly higher during 2-year follow-up (7.3% vs 2.0%, P < .0001), as was cardiac mortality (2.4% vs 0.8%, P = .004), reinfarction (9.4% vs 5.2%, P = .0009), stent thrombosis (7.0% vs 3.8%, P = .007), and ischemic target vessel revascularization (19.4% vs 11.8%, P < .0001). CONCLUSION In the HORIZONS-AMI trial, the development of new-onset CHF within 2 years after contemporary PCI, although infrequent, was associated with significantly increased rates of mortality and major adverse ischemic events.
Collapse
|
45
|
Amino-Terminal Pro–B-Type Natriuretic Peptide (NT-proBNP) Levels 3 Months After Myocardial Infarction Are More Strongly Associated With Magnetic Resonance–Determined Ejection Fraction Than NTproBNP Levels in the Acute Phase. J Card Fail 2011; 17:479-86. [DOI: 10.1016/j.cardfail.2011.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/08/2011] [Accepted: 02/24/2011] [Indexed: 11/21/2022]
|
46
|
Predictive value of ischemic mitral regurgitation during the acute phase of ST elevation myocardial infarction treated with primary coronary intervention for left ventricular remodeling in long-term follow-up. Coron Artery Dis 2011; 21:325-9. [PMID: 20453641 DOI: 10.1097/mca.0b013e32833aa6bb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Reperfusion therapy, mainly primary percutaneous coronary intervention (PCI), has improved survival and lowered complication rate in patients with ST elevation myocardial infarction (STEMI). Nevertheless, some patients develop left ventricular remodeling (LVR) during long-term follow-up. AIMS To assess the incidence of ischemic mitral regurgitation (MR) in the acute phase of STEMI treated with primary PCI. To assess prognostic value of MR during acute STEMI for prediction of LVR during long-term follow-up. METHODS This is a prospective, single-center study in 83 patients with the first STEMI. Inclusion criteria were as follows: time from symptom onset to PCI less than 12 h and successful restoration of blood flow (thrombolysis in myocardial infarction 3) in the infarct-related coronary artery. Transthoracic echocardiography was performed at discharge and 6 months after the MI. RESULTS At hospital discharge, ischemic MR was found in 35 (42%) patients. At 6 months follow-up, LVR was present in 21 (25%) patients. Univariate analysis revealed that remodeling could be predicted by age, weight, treatment with abciximab, left ventricular ejection fraction (LVEF), leaflets coaptation, coaptation height, tenting area, presence of MR, degree of MR. The best multivariate logistic regression model for remodeling prediction at 6 months was combination of ischemic MR degree (odds ratio (OR)=14.5; 95% confidence interval (CI): 3.89-54.0, P<0.00005), abciximab therapy (OR=0.09; 95% CI: 0.01-0.84, P<0.03) and LVEF (OR=0.89; 95% CI: 0.81-0.99, P<0.03). CONCLUSION Ischemic MR in STEMI is frequent, even despite effective primary PCI. The regurgitation grade and lower LVEF assessed at hospital discharge and lack of abciximab administration could predict development of LVR at 6 months.
Collapse
|
47
|
Boonbaichaiyapruck S, Pienvichit P, Limpijarnkij T, Rerkpattanapipat P, Pongpatananurak A, Saelee R, Ungkanont A, Hongeng S. Transcoronary infusion of bone marrow derived multipotent stem cells to preserve left ventricular geometry and function after myocardial infarction. Clin Cardiol 2010; 33:E10-5. [PMID: 20552656 DOI: 10.1002/clc.20545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Myocardial damage after myocardial infarction (MI) was deemed irreversible after late reperfusion. Administration of multipotent stem cell (MSC) into such infarct may regenerate the myocardium and capillary network. HYPOTHESIS Transcoronary infusion of bone marrow derived multipotent stem cells into infarcted related artery after acute myocardial infarction is feasible, safe and improve left ventricular function. METHODS We conducted a pilot study in patients who survived ST-elevation MI with late reperfusion therapy and remained hemodynamically stable. Bone marrow derived MSC was infused into a patent infarct-related coronary artery during brief low pressure (2 atm) balloon inflation. A 3-T gadolinium-based MRI was performed at baseline and 8 weeks later to evaluate infarct area and LV function. RESULTS We enrolled 10 patients, age 63.8 +/- 2.8 years 5.2 +/- 4.12 x 10(6) MSC were infused via coronary artery 24.8 +/- 16 days after infarction. The procedures were successful in all patients without any in-hospital event. Infarct size by MRI decreased by 5.84% (P = .018) over 8 weeks. Mean baseline left ventricular ejection fraction (LVEF) was 44.1% +/- 9% and was 46.3% +/- 9% at 8 weeks (P = .34). A trend of smaller LV end-systolic volume with 65.02 +/- 18.2 ml vs 63.04 +/- 21.89 ml (P = .09) with no change of LV end-diastolic volume observed. CONCLUSION MSC infusion into coronary circulation was feasible and safe after myocardial infarction. Infarct size was reduced with preservation of LV geometry.
Collapse
Affiliation(s)
- Sarana Boonbaichaiyapruck
- Cardiac Catheterization and intervention Services, Cardiology Unit, Department of Internal Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
van der Schaaf RJ, Claessen BE, Hoebers LP, Verouden NJ, Koolen JJ, Suttorp MJ, Barbato E, Bax M, Strauss BH, Olivecrona GK, Tuseth V, Glogar D, Råmunddal T, Tijssen JG, Piek JJ, Henriques JPS. Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Trials 2010; 11:89. [PMID: 20858263 PMCID: PMC2949852 DOI: 10.1186/1745-6215-11-89] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 09/21/2010] [Indexed: 01/28/2023] Open
Abstract
Background In the setting of primary percutaneous coronary intervention, patients with a chronic total occlusion in a non-infarct related artery were recently identified as a high-risk subgroup. It is unclear whether ST-elevation myocardial infarction patients with a chronic total occlusion in a non-infarct related artery should undergo additional percutaneous coronary intervention of the chronic total occlusion on top of optimal medical therapy shortly after primary percutaneous coronary intervention. Possible beneficial effects include reduction in adverse left ventricular remodeling and preservation of global left ventricular function and improved clinical outcome during future coronary events. Methods/Design The Evaluating Xience V and left ventricular function in Percutaneous coronary intervention on occLusiOns afteR ST-Elevation myocardial infarction (EXPLORE) trial is a randomized, prospective, multicenter, two-arm trial with blinded evaluation of endpoints. Three hundred patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction with a chronic total occlusion in a non-infarct related artery are randomized to either elective percutaneous coronary intervention of the chronic total occlusion within seven days or standard medical treatment. When assigned to the invasive arm, an everolimus-eluting coronary stent is used. Primary endpoints are left ventricular ejection fraction and left ventricular end-diastolic volume assessed by cardiac Magnetic Resonance Imaging at four months. Clinical follow-up will continue until five years. Discussion The ongoing EXPLORE trial is the first randomized clinical trial powered to investigate whether recanalization of a chronic total occlusion in a non-infarct related artery after primary percutaneous coronary intervention for ST-elevation myocardial infarction results in a better preserved residual left ventricular ejection fraction, reduced end-diastolic volume and enhanced clinical outcome. Trial registration trialregister.nl NTR1108.
Collapse
Affiliation(s)
- René J van der Schaaf
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Dambrink JH, Debrauwere J, van 't Hof A, Ottervanger JP, Gosselink A, Hoorntje J, de Boer MJ, Suryapranata H. Non-culprit lesions detected during primary PCI: treat invasively or follow the guidelines? EUROINTERVENTION 2010. [DOI: 10.4244/eijv5i8a162] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
50
|
van Melle JP, van der Vleuten PA, Hummel YM, Nijveldt R, Tio RA, Voors AA, Zijlstra F. Predictive value of tissue Doppler imaging for left ventricular ejection fraction, remodelling, and infarct size after percutaneous coronary intervention for acute myocardial infarction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:596-601. [PMID: 20211849 DOI: 10.1093/ejechocard/jeq023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate in ST-elevation myocardial infarction (STEMI) patients the value of tissue Doppler imaging (TDI) for an early estimation of the extent of myocardial salvage, left ventricular (LV) remodelling, and residual LV ejection fraction (LVEF). METHODS AND RESULTS In 50 STEMI patients hospitalized for primary percutaneous coronary intervention (PCI), we investigated whether TDI can predict LVEF, infarct size, and LV remodelling as measured by magnetic resonance imaging (MRI) at 4 months post-MI. TDI was assessed within 24 h after MI with colour-coded TDI. Systolic and diastolic velocities from the six basal myocardial segments derived from three standard apical windows were averaged as a measure of global longitudinal velocity (i.e. Sm-6 and Em-6/Am-6, respectively). Sm-6 was shown to be a significant predictor of LVEF at 4 months. In addition, Sm-6 was a significant predictor of infarct size. No significant correlations were found between Sm-6 and LV remodelling. In addition, Sm-6 appeared to be a valuable clinical tool for identification of patients with LVEF > 40% or LVEF < 40% with acceptable positive predictive values. CONCLUSION Sm-6 is a significant predictor of post-MI LVEF and infarct size as measured by MRI. In contrast, TDI-derived velocities do not predict LV remodelling.
Collapse
Affiliation(s)
- Joost P van Melle
- Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|