Prognostic use of echocardiography 1 year after a myocardial infarction
Hicham Skali1, Leonardo A M Zornoff, Marc A Pfeffer
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
One year after myocardial infarction (MI), impaired left ventricular (LV) and right ventricular (RV) function predict future heart failure (HF) or death. This late cardiac function assessment offers crucial prognostic information for MI survivors.
Area of Science:
- Cardiology
- Cardiac Imaging
- Prognostics
Background:
- Left ventricular (LV) and right ventricular (RV) function are established predictors of outcomes post-myocardial infarction (MI).
- The prognostic value of assessing cardiac function one year after MI is not well-defined.
Purpose of the Study:
- To evaluate the prognostic significance of LV and RV function assessed one year after MI in patients with baseline LV dysfunction.
- To determine if late cardiac function predicts future morbidity and mortality.
Main Methods:
- Analysis of echocardiograms from 291 patients one year post-MI with baseline LV ejection fraction (EF) < or = 40% from the SAVE study.
- Exclusion of patients who developed heart failure (HF) or recurrent MI within the first year.
- Assessment of LV EF and RV fractional area change at the one-year mark.
Main Results:
- A low LV EF (< 30%) at one year post-MI was linked to a 2.7-fold increased risk of death and/or HF.
- RV dysfunction independently predicted increased risk of death (HR 8.9), HF (HR 7.1), and composite endpoint (HR 7.6).
- Biventricular dysfunction conferred the highest risk (HR 19.4) for death and/or HF.
Conclusions:
- In stable MI survivors, impaired LV and RV function one year post-MI are independent predictors of increased risk.
- Cardiac function assessment at one year post-MI provides additive prognostic information for HF or death.
- Late evaluation of biventricular function is critical for risk stratification in MI survivors.
Background:
Left ventricular (LV) and right ventricular (RV) function are known predictors of morbidity and mortality after an acute myocardial infarction (MI). However, the prognostic use of a late evaluation of cardiac function after an MI remains unclear.
Methods:
We analyzed echocardiograms obtained 1 year after MI in patients with LV dysfunction at baseline (ejection fraction [EF] < or = 40%) from 291 patients enrolled in the SAVE echocardiographic substudy who did not develop heart failure (HF) or a recurrent MI during this first year. Left ventricular EF and RV fractional area change were assessed.
Results:
After a median follow-up of 22 months after the 1-year echocardiogram, a low LVEF (< 30%) at 1 year was associated with an increased risk of death and/or HF (hazards ratio [HR] 2.7, 95% CI 1.3-5.3). Presence of RV dysfunction was also associated with an increased risk of death (HR 8.9, 95% CI 3.5-22.1), development of HF (HR 7.1, 95% CI 3.4-15.0), and the composite end point of death or HF (HR 7.6, 95% CI 4.1-14.2). In multivariate analyses, both low LVEF and RV dysfunction remained independently predictive of the composite end point of death or HF. Patients with biventricular dysfunction were at the greatest risk of death and/or HF (HR 19.4, 95% CI 8.2-46.0) in follow-up.
Conclusions:
In a stable population of survivors of MI, impaired LV and RV function at 1 year after MI are independently and additively predictive of increased risk of HF or death.
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