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Left ventricular ejection fraction reassessment post–myocardial infarction: Current clinical practice and determinants of adverse remodeling
- Source :
- American Heart Journal. 198:91-96
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Left ventricular (LV) dysfunction may be sustained or aggravated during the convalescent months following an acute myocardial infarction (MI) and is difficult to predict. We sought to determine current practice patterns of LV ejection fraction (LVEF) reassessment during the months following MI and evaluate the predictors and clinical significance of LVEF change in a prospective post-MI patient cohort.Patients with an acute MI between June 2010 and August 2014 were identified using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry. Patients with initial LV dysfunction (LVEF40% with first MI or45% with multiple MI events) underwent a protocol-driven repeat LVEF assessment in follow-up if routine LVEF reassessment was not performed.Of 5,964 MI patients, follow-up LVEF assessments were attained for 442 of the 695 patients who had significant LV dysfunction. A sizable proportion (25%) had either no increase or a decline in LVEF. Adverse remodeling was associated with an anterior MI location, a greater peak serum troponin T, and a higher baseline LVEF at time of MI. Adverse LV remodeling conferred a 3-fold risk of death (hazard ratio 3.0, 95% CI 1.6-5.7, P=.001) adjusted for baseline LVEF, anterior MI location, and medication use.Current practice of LVEF reassessment during the convalescent months post-MI is suboptimal despite a sizeable proportion of patients that undergo adverse LV remodeling. Targeting processes affecting low rates of LVEF reassessment may reduce missed care opportunities and ensure that patients consistently receive appropriate evidence-based and guideline-recommended care.
- Subjects :
- Male
medicine.medical_specialty
Databases, Factual
Myocardial Infarction
030204 cardiovascular system & hematology
Risk Assessment
Alberta
Cohort Studies
Ventricular Dysfunction, Left
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Internal medicine
medicine
Humans
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Survival rate
Aged
Retrospective Studies
Ejection fraction
Ventricular Remodeling
biology
business.industry
Hazard ratio
Age Factors
Stroke Volume
Retrospective cohort study
Recovery of Function
Middle Aged
Prognosis
medicine.disease
Troponin
Echocardiography, Doppler
Survival Rate
Logistic Models
Multivariate Analysis
Cohort
cardiovascular system
biology.protein
Cardiology
Female
Myocardial infarction diagnosis
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00028703
- Volume :
- 198
- Database :
- OpenAIRE
- Journal :
- American Heart Journal
- Accession number :
- edsair.doi.dedup.....5085cb70a1cff5e08cccdf4fb0b5ede4