Predictors and prognosis for incident in-hospital heart failure in patients with preserved ejection fraction after first acute myocardial infarction

Abstract

Patients with acute myocardial infarction (AMI) complicated by heart failure with preserved ejection fraction (HFpEF) are likely to have more adverse cardiovascular events and higher mortality. The purpose of this study was to examine the predictors and outcomes in AMI patients complicated by HFpEF.We examined the demographics, clinical data, and clinical outcomes in 405 consecutive subjects who firstly presented with AMI after undergoing emergency percutaneous coronary intervention from January 2013 to June 2016.Three hundred twenty patients and eighty-five patients were classified into the nonheart failure (non-HF) group and HFpEF group, respectively. Patients with HFpEF had higher prevalence of prior hypertension, had higher levels of biomarkers, and had a larger left atrial diameter with a nondilated left ventricle were more likely to develop multivessel disease-vessels and had infarction-related artery located in left anterior descending artery than patients without HF. Moreover, patients with HFpEF had a higher probability of developing the in-hospital incident cardiovascular complications and death than non-HF patients.Two routine biomarkers, levels of hypersensitive C-reactive protein and N-terminal-pro brain natriuretic peptide, and number of diseased-vessels were independent predictors for in-hospital HFpEF incidence in AMI patients with preserved LVEF. AMI patients with HFpEF had a higher probability of in-hospital cardiovascular outcomes and mortality.

Heart failure after myocardial infarction: incidence and predictors

“…Several studies have shown the association of troponin or CK‐MB level with MACE, including HF 19,63,64 . Yet the association of peak troponin or CK‐MB with HF has not been seen in all investigations 65,66 …”

“…Numerous methods of inflammatory response quantification have shown promise in HF prediction. C‐reactive protein level predicted the risk of adverse events after MI, including HF, in several studies 74–77 . The neutrophil‐to‐lymphocyte ratio, an indicator of systemic inflammation, predicted MACE and HF in a meta‐analysis of 14 studies 78 …”

“…19,63,64 Yet the association of peak troponin or CK-MB with HF has not been seen in all investigations. 65,66…”

“…Alongside troponin, natriuretic peptides are associated with infarct size and cardiac dysfunction. 67,68 In addition to the magnitude of natriuretic peptides elevation, 66,69 its pattern is also associated with adverse events. While in some patients the brain natriuretic peptide increase after MI has a monophasic pattern with a peak at 16 h after admission, in others, the rise is biphasic with a second peak at 5 days.…”

“…C-reactive protein level predicted the risk of adverse events after MI, including HF, in several studies. [74][75][76][77] The neutrophil-to-lymphocyte ratio, an indicator of systemic inflammation, predicted MACE and HF in a meta-analysis of 14 studies. 78 Cytokines are strategic regulators of inflammation.…”