Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions
BackgroundLeft 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.MethodsData from a single-c...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1051995/full |
| _version_ | 1798015345438490624 |
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| author | Peter Wohlfahrt Peter Wohlfahrt Dominik Jenča Dominik Jenča Vojtěch Melenovský Marek Šramko Martin Kotrč Michael Želízko Jolana Mrázková Věra Adámková Jan Pitha Josef Kautzner Josef Kautzner |
| author_facet | Peter Wohlfahrt Peter Wohlfahrt Dominik Jenča Dominik Jenča Vojtěch Melenovský Marek Šramko Martin Kotrč Michael Želízko Jolana Mrázková Věra Adámková Jan Pitha Josef Kautzner Josef Kautzner |
| author_sort | Peter Wohlfahrt |
| collection | DOAJ |
| description | BackgroundLeft 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.MethodsData from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized.ResultsOut 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.ConclusionsDespite 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. |
| first_indexed | 2024-04-11T15:32:52Z |
| format | Article |
| id | doaj.art-de1df35f829b4df89220837b1c0e227f |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T15:32:52Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-de1df35f829b4df89220837b1c0e227f2022-12-22T04:16:06ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.10519951051995Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventionsPeter Wohlfahrt0Peter Wohlfahrt1Dominik Jenča2Dominik Jenča3Vojtěch Melenovský4Marek Šramko5Martin Kotrč6Michael Želízko7Jolana Mrázková8Věra Adámková9Jan Pitha10Josef Kautzner11Josef Kautzner12Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaFirst Medical School, Charles University, Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaThird Medical School, Charles University, Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaDepartment of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, CzechiaMedical and Dentistry School, Palacký University, Olomouc, CzechiaBackgroundLeft 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.MethodsData from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized.ResultsOut 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.ConclusionsDespite 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.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1051995/fullmyocardial infarctionejection fraction (EF%)systolic dysfunctioninflammationatrial fibrillationepidemiology |
| spellingShingle | Peter Wohlfahrt Peter Wohlfahrt Dominik Jenča Dominik Jenča Vojtěch Melenovský Marek Šramko Martin Kotrč Michael Želízko Jolana Mrázková Věra Adámková Jan Pitha Josef Kautzner Josef Kautzner Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions Frontiers in Cardiovascular Medicine myocardial infarction ejection fraction (EF%) systolic dysfunction inflammation atrial fibrillation epidemiology |
| title | Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| title_full | Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| title_fullStr | Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| title_full_unstemmed | Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| title_short | Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| title_sort | trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions |
| topic | myocardial infarction ejection fraction (EF%) systolic dysfunction inflammation atrial fibrillation epidemiology |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1051995/full |
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