Abstract
BackgroundLeft ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI.MethodsEchocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF.ResultsEarly in-hospital CHF occurred in 29 (31%) of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients.ConclusionFor patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.
Highlights
Detection of patients with acute myocardial infarction (AMI) at risk of development of in-hospital congestive heart failure (CHF) is necessary to limit myocardial injury and left ventricular (LV) dysfunction
We aimed to analyze the role of the Myocardial performance index (MPI) and left atrial (LA) volume compared to other conventional parameters of systolic and diastolic LV function in an homogeneous group of patients with a first, isolated ST-elevation AMI, in predicting early CHF during in-hospital evolution
Patients We studied prospectively 95 consecutive patients (58 ± 12 years old, 64 males) admitted to our coronary care unit with a first ST-elevation AMI, defined as characteristic chest pain lasting for more than 20 minutes, typical ST segment elevation > 1 mm in at least two contiguous leads associated with transient rise of creatine kinase MB
Summary
Detection of patients with acute myocardial infarction (AMI) at risk of development of in-hospital congestive heart failure (CHF) is necessary to limit myocardial injury and left ventricular (LV) dysfunction. Some authors [11,13,14] considered diverse in-hospital complications besides CHF (recurrent angina, reinfarction, death, arrhythmias, heart block, cardiac rupture and pericardial effusion), not always solely related to the extend of LV dysfunction in the acute phase of AMI These factors may justify some controversy about the short-term independent prognostic significance of MPI in AMI patients, defended by some [10,11,14] but questioned by others [12,13]. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) in patients with a first isolated ST-elevation AMI
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