Left Ventricular Remodeling and Heart Failure Predictors in Acute Myocardial Infarction Patients with Preserved Left Ventricular Ejection Fraction after Successful Percutaneous Intervention in Western Romania.

Abstract

Simple SummaryAcute myocardial infarction patients are at high risk for heart failure, even after successful revascularization therapy. We performed a study that aimed to identify early predictors of heart failure after myocardial infarction. The study included 244 patients discharged with a normal heart function after their first myocardial infarction. At the 2- year follow-up, we found that 186 (76%) showed an improvement in left ventricular function and 61 (24%) had a deterioration of the latter. Comparing the two groups, we found patients in the latter group were older, more often hypertensive, smokers, and had more severe clinical presentations of the acute myocardial infarction and more extensive coronary disease. A total of 19 patients (8%) had experienced hospitalizations for heart failure, 6% being from group I and 12 % from group II, and this difference was notable. We observed that the presence of heart failure at the admission for acute myocardial infarction and abnormal deformation patterns of the infarct-related myocardial segments detected by echocardiography accurately predicted the occurrence of heart failure during the next two years. The presence of these parameters might enable a better risk-stratification and initiation of an effective preventive therapy in acute myocardial infarction patients.(1) Acute myocardial infarction (AMI) patients are at risk of left ventricular (LV) remodeling and heart failure (HF), even after successful revascularization by percutaneous coronary intervention (PCI). We wanted to assess the independent predictors of these outcomes in AMI patients. (2) Methods: The study enrolled patients with a LVEF ≥50% after a successful PCI for their first AMI. After 24 months, patients were separated into two groups based on whether their LVEF remained ≥50% (group I), or decreased to <50% (group II). (3) Outcomes: 26% of the patients experienced a decrease in LVEF below 50%, 41% showed LV remodeling, and 8% had experienced HF hospitalizations. HF hospitalizations were significantly more frequent in group II patients (p < 0.0001). The Killip class at admission >2, infarct-related longitudinal strain ≤−12.5%, and the presence of LV remodeling were identified as independent predictors of HF hospitalizations. (4) Conclusions: About 26% of AMI patients with normal LV function after a successful PCI developed HF. More sensitive techniques are required that allow for a more efficient risk-stratification and preventive therapy to reduce LV remodeling and HF in AMI patients with LVEF ≥50% after a successful PCI. The detection of abnormal ventricular deformation patterns after PCI by speckle-tracking echocardiography might be a valuable method in this approach.