Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction

Abstract

BackgroundThe prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated.ObjectiveTo analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality.MethodsPatients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models.ResultsAmong the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality.ConclusionOne-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.

Left atrial volume index to left ventricular ejection fraction ratio predicted major adverse cardiovascular event in ST-Elevated myocardial infarction patients during 8 years of follow-up

“…showed that those who were developed HFpEF had a 3-fold higher mortality risk than those without HF among patients with acute MI. [ 24 ] Therefore, the parameters that imply these patients would provide more accurate evidence about surveillance for sure. In the present study, LAVI/LVEFr was a significant predictor of MACE in the fully adjusted model.…”

Effects of captopril and valsartan on ventricular remodeling and inflammatory cytokines after interventional therapy for AMI

“…This is because captopril is an angiotensin-converting enzyme inhibitor that reduces ventricular filling pressure and vascular resistance. Captopril treatment after PCI can reduce left ventricular load and early myocardial remodeling, protect cardiac ejection fraction, and improve myocardial compliance and relaxation ability ( 13 ). Valsartan is an angiotensin II receptor antagonist, with the effect of dilating blood vessels to lower blood pressure, which can increase coronary perfusion in infarcted and non-infarcted areas, thereby reducing left ventricular end-diastolic pressure and reducing LVEDV and LVESV ( 14 ).…”

Prognosis in heart failure with preserved ejection fraction

“…Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization. [15] Independent predictors of mortality in patients with HFpEF in different studies include older age, male gender, New York Heart Association (NYHA) class, lower LVEF, the extent of coronary artery disease, peripheral artery disease, diabetes, impaired renal function, the degree of diastolic dysfunction as assessed by Doppler echocardiography, and increased red cell distribution width Morbidity outcomes in HFrEF and HFpEF are similar. These include the rate and frequency of hospitalization for HF, symptomatic status as measured by abnormalities in myocardial oxygen consumption, six-minute walk distance, Minnesota Living with Heart Failure questionnaire scores, and other quality-oflife indicators.…”