Recovery of Left Ventricular Ejection Fraction Post-Acute Coronary Syndrome

Abstract

A reduction in left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is associated with increased mortality. Recovery of LVEF correlates with an improved prognosis. There is little data about whether LVEF is being investigated post-MI in local practice and which factors are associated with the improvement of LVEF. Using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) Registry and patient notes, retrospective analysis of admissions to the Auckland City Hospital Coronary Care Unit between January 2015 and December 2016 for MI with reduced LVEF (<50%) or unknown LVEF was performed. Of the 824 patients with reduced or unknown LVEF, 414 (50.2%) received both initial and follow-up investigations of LVEF at any time. Patients with initial LVEFs between 40%–49.9%, 30%–39.9% and <30% had follow up investigation rates of 54.0%, 73.1% and 66.7%, respectively.186 (22.6%) patients were deceased by December 2020. The median initial LVEF of patients that received both initial and follow-up studies was 37.5% (32.5–44.0). At follow-up, median LVEF was 42.5% (35.0–50.0). 165 (39.9%) patients in this group experienced an increase of >10% in LVEF between initial and follow-up assessments. Patients with reduced LVEF post-MI suffer from high mortality, and the local practice of assessing LVEF is deficient. Encouragingly, a significant proportion of patients that received follow-up experienced an increase in LVEF. Further evaluation may establish which patient factors and medical treatments influence this recovery.