Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy

Abstract Background Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implan...

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Main Authors: Rona Reibis, Annett Salzwedel, Klaus Bonaventura, Heinz Völler, Karl Wegscheider
Format: Article
Language:English
Published: BMC 2017-07-01
Series:BMC Research Notes
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13104-017-2562-4
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author Rona Reibis
Annett Salzwedel
Klaus Bonaventura
Heinz Völler
Karl Wegscheider
author_facet Rona Reibis
Annett Salzwedel
Klaus Bonaventura
Heinz Völler
Karl Wegscheider
author_sort Rona Reibis
collection DOAJ
description Abstract Background Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD). Methods We performed a retrospective analysis of 277 patients with reduced LVEF at least 1 month after MI and complete revascularization. Patients (median time post-MI 23.4 months; 74.3% after PCI, 25.7% after CABG were assigned either to group 1 (LVEF <30%) or group 2 (LVEF 30–40%). Biplane echocardiography was redone after a mean follow-up of 441 ± 220 days. Results LVEF increased significantly in both two groups (group 1: 26.2 ± 4.8% to 32.4 ± 8.5%; p < 0.001; group 2: 38.2 ± 2.5% to 44.4 ± 9.6%; p < 0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37% (p < 0.001) with a large interindividual variation. Conclusions The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.
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spelling doaj.art-ce8b2de890eb4359a11b1d4ba0877a292022-12-22T01:24:47ZengBMCBMC Research Notes1756-05002017-07-011011810.1186/s13104-017-2562-4Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacyRona Reibis0Annett Salzwedel1Klaus Bonaventura2Heinz Völler3Karl Wegscheider4Cardiological Outpatient Clinic Am Park SanssouciCenter of Rehabilitation Research, University of PotsdamDepartment of Cardiology and Angiology, Ernst von Bergmann HospitalCenter of Rehabilitation Research, University of PotsdamDepartment of Medical Biometry and Epidemiology, University Medical Center Hamburg-EppendorfAbstract Background Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD). Methods We performed a retrospective analysis of 277 patients with reduced LVEF at least 1 month after MI and complete revascularization. Patients (median time post-MI 23.4 months; 74.3% after PCI, 25.7% after CABG were assigned either to group 1 (LVEF <30%) or group 2 (LVEF 30–40%). Biplane echocardiography was redone after a mean follow-up of 441 ± 220 days. Results LVEF increased significantly in both two groups (group 1: 26.2 ± 4.8% to 32.4 ± 8.5%; p < 0.001; group 2: 38.2 ± 2.5% to 44.4 ± 9.6%; p < 0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37% (p < 0.001) with a large interindividual variation. Conclusions The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.http://link.springer.com/article/10.1186/s13104-017-2562-4Myocardial infarctionHeart failureCardioverter-defibrillatorRegression toward the mean
spellingShingle Rona Reibis
Annett Salzwedel
Klaus Bonaventura
Heinz Völler
Karl Wegscheider
Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
BMC Research Notes
Myocardial infarction
Heart failure
Cardioverter-defibrillator
Regression toward the mean
title Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
title_full Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
title_fullStr Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
title_full_unstemmed Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
title_short Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
title_sort improvement of left ventricular ejection fraction in revascularized postmyocardial patients indication for statistical fallacy
topic Myocardial infarction
Heart failure
Cardioverter-defibrillator
Regression toward the mean
url http://link.springer.com/article/10.1186/s13104-017-2562-4
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