Prognostic value of short-term trajectories of left ventricular ejection fraction in patients with first myocardial infarction and percutaneous coronary intervention

Aim. To assess periprocedural dynamics of left ventricular ejection fraction (LVEF) in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) without heart failure (HF) in the medical history, as well as its prognostic value in the development of cardiovascular complications in the postinfarction period.

Materials and methods. A prospective, single-center observational study included 131 patients with first AMI without HF in the past medical history and successful PCI. LVEF was assessed before PCI at admission and before discharge. In patients with reduced baseline LVEF of less than 50%, the criteria for its periprocedural improvement were chosen: 1) LVEF ≥ 50%; 2) ΔLVEF of more than 5%, but EF < 50%. The endpoints were hospitalization for the development of HF and death from cardiovascular disease in combination with the development of HF. The average follow-up period was 2.5 years.

Results. At admission, LVEF was < 50% in 74 (56.5%) patients. At discharge, according to the criteria for LVEF improvement, the proportion of patients in this group was 40.5 and 14.9%, respectively. In 44.6% of cases, no increase in LVEF was noted. The predictors of the absence of periprocedural dynamics in LFEF included impaired regional contractility index > 1.94, left ventricular end-systolic volume > 57 ml, left ventricular end-diastolic diameter > 5.1 cm, pulmonary artery systolic pressure >27 mm Hg, NT-proBNP > 530 pg / ml, and E / A ratio > 1.06. During the follow-up period, 28 (21.4%) patients were hospitalized for the development of HF, 33 (25.2%) patients had a combined endpoint. The absence of periprocedural improvement in left ventricular contractility was independently associated with higher odds of hospitalization for HF (relative risk (RR) 3.5; 95% confidence interval (CI) 1.63–7.55; p = 0.001) and the combined endpoint (RR 2.6; 95% CI 1.28–5.48; p = 0.009) in the postinfarction period.

Conclusion. In patients with first AMI and left ventricular systolic dysfunction, periprocedural evaluation of LVEF is reasonable to stratify the risk of adverse cardiovascular outcomes.

1. Ye Q., Zhang J., Ma L. Predictors of all-cause 1-year mortality in myocardial infarction patients. Medicine (Baltimore). 2020;99(29):e21288. DOI: 10.1097/MD.0000000000021288.

2. Amsterdam E.A., Wenger N.K., Brindis R.G., Casey D.E. Jr., Ganiats T.G., Holmes D.R. Jr. et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014;64(24):e139–e228. DOI: 10.1016/j.jacc.2014.09.017. Erratum in: J. Am. Coll. Cardiol. 2014;64(24):2713–2714. Dosage error in article text. DOI: 10.1016/j.jacc.2014.09.017.

3. O'Gara P.T., Kushner F.G., Ascheim D.D., Casey D.E. Jr., Chung M.K., de Lemos J.A. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362–425. DOI: 10.1161/CIR.0b013e3182742cf6.

4. Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018;39(2):119–177. DOI: 10.1093/eurheartj/ehx393.

5. Ahnve S., Gilpin E., Dittrich H., Nicod P., Henning H., Carlisle J. et al. First myocardial infarction: age and ejection fraction identify a low-risk group. Am. Heart J. 1988;116(4):925–932. DOI: 10.1016/0002-8703(88)90142-1.

6. Федорова Н.В., Герман А.И., Коков А.Н., Брель Н.К., Печерина T.Б., Кашталап В.В. и др. Эхокардиографические корреляты фиброза миокарда у пациентов с инфарктом миокарда и сохранной фракцией выброса левого желудочка. Фундаментальная и клиническая медицина. 2019;4(2):17–27. DOI: 10.23946/2500-0764-2019-4-2-17-27.

7. Гарганеева А.А., Борель К.Н., Округин С.А., Кужелева Е.А. Влияние фракции выброса левого желудочка на отдаленный прогноз пациентов, перенесших коронарную катастрофу. Анализ 5-летнего мониторинга в рамках популяционной программы «Регистр острого инфаркта миокард». Сердечная недостаточность. 2014;15(4):218–223.

8. Oh P.C., Choi I.S., Ahn T., Moon J., Park Y., Seo J.G. et al. 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(8):527–533. DOI: 10.4070/kcj.2013.43.8.527.

9. Sjöblom J., Muhrbeck J., Witt N., Alam M., Frykman-Kull V. Evolution of left ventricular ejection fraction after acute myocardial infarction: implications for implantable cardioverter-defibrillator eligibility. Circulation. 2014;130(9):743–748. DOI: 10.1161/CIRCULATIONAHA.114.009924.

10. Жарикова Е.С., Виллевальде С.В., Кобалава Ж.Д. Предикторы неблагоприятного ремоделирования левого желудочка у пациентов, перенесших инфаркт миокарда. Вестник Российского университета дружбы народов. Серия: Медицина. 2017;21(2):219–226. DOI: 10.22363/2313-02452017-21-2-219-226.

11. Chew D.S., Heikki H., Schmidt G., Kavanagh K.M., Dommasch M., Bloch Thomsen P.E. et al. Change in left ventricular ejection fraction following first myocardial infarction and outcome. JACC Clin. Electrophysiol. 2018;4(5):672–682. DOI: 10.1016/j.jacep.2017.12.015.

12. Chew D.S., Wilton S.B., Kavanagh K., Southern D.A., Tan-Mesiatowsky L.E., Exner D.V. et al. Left ventricular ejection fraction reassessment post-myocardial infarction: Current clinical practice and determinants of adverse remodeling. Am. Heart J. 2018;198:91–96. DOI: 10.1016/j.ahj.2017.11.014.

13. Ohashi J., Sakakura K., Yamamoto K., Taniguchi Y., Tsukui T., Seguchi M. et al. Determinants of improvement of mid-term ejection fraction in patients with acute myocardial infarction. Int. Heart J. 2019;60(6):1245–1252. DOI: 10.1536/ihj.19-126.

14. Minicucci M.F., Farah E., Fusco D.R., Cogni A.L., Azevedo P.S., Okoshi K. et al. Infarct size as predictor of systolic functional recovery after myocardial infarction. Arq. Bras. Cardiol. 2014;102(6):549–556. DOI: 10.5935/abc.20140051.

15. Wu W.Y., Biery D.W., Singh A., Divakaran S., Berman A.N., Ayuba G. et al. Recovery of left ventricular systolic function and clinical outcomes in young adults with myocardial infarction. J. Am. Coll. Cardiol. 2020;75(22):2804–2815. DOI: 10.1016/j.jacc.2020.03.074.

16. Gupta A., Wang Y., Spertus J.A., Geda M., Lorenze N., Nkonde-Price C. et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J. Am. Coll. Cardiol. 2014;64(4):337–345. DOI: 10.1016/j.jacc.2014.04.054.

17. Wilmot K.A., O'Flaherty M., Capewell S., Ford E.S., Vaccarino V. Coronary heart disease mortality declines in the United States from 1979 through 2011: Evidence for stagnation in young adults, especially women. Circulation. 2015;132(11):997–1002. DOI: 10.1161/CIRCULATIONAHA.115.015293.

18. Yandrapalli S., Nabors C., Goyal A., Aronow W.S., Frishman W.H. Modifiable risk factors in young adults with first myocardial infarction. J. Am. Coll. Cardiol. 2019;73(5):573–584. DOI: 10.1016/j.jacc.2018.10.084.

19. Thygesen K., Alpert J.S., Jaffe A.S., Chaitman B.R., Bax J.J., Morrow D.A. et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20):e618-e651. DOI: 10.1161/CIR.0000000000000617.

20. Belghitia H., Brette S., Lafitte S., Reant P., Picard F., Serri K. et al. Automated function imaging: a new operator-independent strain method for assessing left ventricular function. Arch. Cardiovasc. Dis. 2008;101(3):163–169. DOI: 10.1016/s1875-2136(08)71798-4.

21. Amundsen B.H., Helle-Valle T., Edvardsen T., Torp H., Crosby J. et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J. Am. Coll. Cardiol. 2006;47(4):789–793. DOI: 10.1016/j.jacc.2005.10.040.

22. Mamedov S., Kobalava Zh., Safarova A., Timofeeva T., Cabello F., Meray I. et al. Prognostic value of subclinical pulmonary congestion in patients with primary acute myocardial infarction and percutaneous coronary intervention. Eur. J. Heart Fail. 2021;23(S2):34–35.

23. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F. 3rd., Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2016;29(4):277–314. DOI: 10.1016/j.echo.2016.01.011.

24. Cohn J.N., Ferrari R., Sharpe N. Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J. Am. Coll. Cardiol. 2000;35(3):569–582. DOI: 10.1016/s0735-1097(99)00630-0. Colvin M.M., Sutton N.R. Left ventricular recovery in young patients with myocardial infarction: How much is enough? J. Am. Coll. Cardiol. 2020;75(22):2816–2818. DOI: 10.1016/j.jacc.2020.04.020.

25. Sutton N.R., Li S., Thomas L., Wang T.Y., de Lemos J.A., Enriquez J.R. et al. The association of left ventricular ejection fraction with clinical outcomes after myocardial infarction: Findings from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With the Guidelines (GWTG) Medicare-linked database. Am. Heart J. 2016;178:65–73. DOI: 10.1016/j.ahj.2016.05.003.

26. Крикунов П.В., Васюк Ю.А., Крикунова O.В. Прогностическая значимость эхокардиографии после острого инфаркта миокарда. Часть 1. Российский кардиологический журнал. 2017;22(12):120–128. DOI: 10.15829/1560-40712017-12-120-128.

27. Gillam L.D., Leipsic J., Weissman N.J. Use of Imaging Endpoints in Clinical Trials. JACC Cardiovasc. Imaging. 2017;10(3):296–303. DOI: 10.1016/j.jcmg.2016.12.003.