Author + information
- Rachid Abou,
- Melissa Leung,
- Georgette Hoogslag,
- Martin Schalij,
- Nina Ajmone Marsan,
- Jeroen Bax and
- Victoria Delgado
Background: Reduced left ventricular ejection fraction (LVEF) is associated with poor prognosis after ST-segment elevation myocardial infarction (STEMI). Little is known about the proportion of STEMI patients with reduced LVEF within 48 hours of admission (baseline) who exhibit LVEF recovery under optimal guideline-based medical treatment. The aim of this study was to evaluate the effect of guideline-based therapy on the recovery of LVEF in STEMI patients.
Methods: Transthoracic echocardiography was performed in 2,853 first STEMI patients treated with primary percutaneous coronary intervention at baseline and at 6 months follow-up. Patients with prior myocardial infarction, re-infarction, coronary artery bypass grafting or incomplete echocardiographic data at 6 months follow-up were excluded. Guideline-based medications were recorded. Reduced LVEF at baseline was defined as ≤40%. LVEF recovery was defined as LVEF ≥50% at 6 months follow-up.
Results: The prevalence of LVEF≤40% at baseline was 13% (n= 371 patients; mean age 60 [range 33-88] years; 76% men). At 6 months follow-up, 31% of patients remained with an LVEF≤40%, 30% showed an LVEF between 41-49% and in 39% LVEF improved to ≥50%. There were no differences in usage of guideline-based medications at discharge across the groups: 99% of patients were treated with angiotensin converting enzyme inhibitors and/or angiotensin II receptor blockers, 94% received beta-blockers and 99% used statins (p>0.05 for variation between groups). Peak troponin levels (odds ratio [OR]: 0.888; p<0.001), baseline LVEF (OR 1.078; p=0.009) and absence of significant mitral regurgitation (OR 0.376; p=0.017) were independently associated with normalization of LVEF (≥50%) at 6 months follow-up.
Conclusions: In contemporary STEMI patients, the prevalence of LVEF≤40% within 48 hours of admission is low. With current guideline-based optimal medical therapy, LVEF normalizes in 39% of the patients. Smaller infarct size as expressed by peak troponin levels, baseline LVEF and absence of significant mitral regurgitation were independently associated with LVEF recovery at six months follow up.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Innovative Use of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1197-227
- 2017 American College of Cardiology Foundation