क्लिनिकल एवं प्रायोगिक कार्डियोलॉजी
खुला एक्सेस

अमूर्त

Novel Predictors of Left Ventricular Systolic Function Recovery in Patients with ST Elevation Myocardial Infarction who Underwent Reperfusion Therapy

J. Nicolás Codolosa, Beatriz Cepeda Valery, Gregg S. Pressman, Abel Romero-Corral, Agustina Sáenz, D. Lynn Morris and Vincent M. Figueredo

Assessment of the left ventricular ejection fraction (LVEF) is important in patients admitted with myocardial infarction as a decreased LVEF is an indicator of poor prognosis. However, early measurement of LVEF can be misleading as patients can show delayed recovery of LVEF. Limited evidence exists regarding the use of predictors of LVEF recovery in patients with ST-elevation myocardial infarction (STEMI). Our aim was to determine if a lower level of cardiac biomarkers and electrocardiographic resolution of the ST elevation (ST–segment resolution of >50%) predicted LVEF recovery in patients with STEMI. We included patients admitted with STEMI to Einstein Medical Center from 2006 to 2008, with an LVEF of <50% during that admission, and a follow-up echocardiogram between 1 to 6 months after the event. A retrospective chart review was performed and 59 patients who underwent reperfusion therapy were included. Patients were identified as having recovery of myocardial function if the LVEF improved ≥ 10% (absolute value) on the subsequent echocardiogram. Both groups (improvement vs. non-improvement) had similar baseline characteristics. Mean age was 62. Forty percent were female, 71% were hypertensive and 46% were diabetic. Predictors of LVEF improvement were absence of dyslipidemia (p=0.01), resolution of the STsegment elevation (p=0.04) and lower troponin levels (highest quartile vs. other 3 quartiles p=0.04). Furthermore, one year mortality was higher in the group that had no LVEF improvement compared to the group with LVEF improvement (26% vs. 0). In conclusion, in patients with STEMI, ST-segment resolution and a lower peak troponin level accurately predicted LVEF recovery 1 to 6 months after the event. If the LVEF improved ≥ 10%, the one year mortality was negligible.