Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction
Aim. To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in rel...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
"Consilium Medicum" Publishing house
2023-05-01
|
| Series: | Терапевтический архив |
| Subjects: | |
| Online Access: | https://ter-arkhiv.ru/0040-3660/article/viewFile/466706/125318 |
| _version_ | 1797808850222448640 |
|---|---|
| author | Tatiana M. Timofeeva Zhanna D. Kobalava Ayten F. Safarova Flora Elisa Cabello Montoya |
| author_facet | Tatiana M. Timofeeva Zhanna D. Kobalava Ayten F. Safarova Flora Elisa Cabello Montoya |
| author_sort | Tatiana M. Timofeeva |
| collection | DOAJ |
| description | Aim. To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period.
Materials and methods. Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF50%; ∆LV EF more than 5%, but LV EF50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (24 B-lines), moderate (59 B-lines) and severe (10 B-lines). The end point was hospitalization for HF for 2.5 years.
Results. Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF50% (in 13.4% of cases; p=0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines 10 on exercise (relative risk 7.45; 95% confidence interval 2.5521.79; p0.000).
Conclusion. Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period. |
| first_indexed | 2024-03-13T06:43:47Z |
| format | Article |
| id | doaj.art-e777d8078f4c459ea3d38efec15cc693 |
| institution | Directory Open Access Journal |
| issn | 0040-3660 2309-5342 |
| language | Russian |
| last_indexed | 2024-03-13T06:43:47Z |
| publishDate | 2023-05-01 |
| publisher | "Consilium Medicum" Publishing house |
| record_format | Article |
| series | Терапевтический архив |
| spelling | doaj.art-e777d8078f4c459ea3d38efec15cc6932023-06-08T14:04:58Zrus"Consilium Medicum" Publishing houseТерапевтический архив0040-36602309-53422023-05-0195429630110.26442/00403660.2023.04.20215978278Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarctionTatiana M. Timofeeva0https://orcid.org/0000-0001-6586-7404Zhanna D. Kobalava1https://orcid.org/0000-0002-5873-1768Ayten F. Safarova2https://orcid.org/0000-0003-2412-5986Flora Elisa Cabello Montoya3https://orcid.org/0000-0002-2334-6675People’s Friendship University of Russia (RUDN University)People’s Friendship University of Russia (RUDN University)Vinogradov City Clinical HospitalPeople’s Friendship University of Russia (RUDN University)Aim. To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period. Materials and methods. Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF50%; ∆LV EF more than 5%, but LV EF50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (24 B-lines), moderate (59 B-lines) and severe (10 B-lines). The end point was hospitalization for HF for 2.5 years. Results. Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF50% (in 13.4% of cases; p=0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines 10 on exercise (relative risk 7.45; 95% confidence interval 2.5521.79; p0.000). Conclusion. Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period.https://ter-arkhiv.ru/0040-3660/article/viewFile/466706/125318acute myocardial infarctionperiprocedural dynamicsejection fractionlung stress ultrasoundheart failure |
| spellingShingle | Tatiana M. Timofeeva Zhanna D. Kobalava Ayten F. Safarova Flora Elisa Cabello Montoya Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction Терапевтический архив acute myocardial infarction periprocedural dynamics ejection fraction lung stress ultrasound heart failure |
| title | Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| title_full | Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| title_fullStr | Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| title_full_unstemmed | Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| title_short | Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| title_sort | prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction |
| topic | acute myocardial infarction periprocedural dynamics ejection fraction lung stress ultrasound heart failure |
| url | https://ter-arkhiv.ru/0040-3660/article/viewFile/466706/125318 |
| work_keys_str_mv | AT tatianamtimofeeva prognosticvalueofperiproceduraldynamicsofleftventricularejectionfractionandsubclinicalpulmonarycongestioninpatientswithmyocardialinfarction AT zhannadkobalava prognosticvalueofperiproceduraldynamicsofleftventricularejectionfractionandsubclinicalpulmonarycongestioninpatientswithmyocardialinfarction AT aytenfsafarova prognosticvalueofperiproceduraldynamicsofleftventricularejectionfractionandsubclinicalpulmonarycongestioninpatientswithmyocardialinfarction AT floraelisacabellomontoya prognosticvalueofperiproceduraldynamicsofleftventricularejectionfractionandsubclinicalpulmonarycongestioninpatientswithmyocardialinfarction |