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Left ventricular function and heart failure in myocardial infarction: impact of the new definition in the community
Adelaide M Arruda-Olson1, Patricia A Pellikka, Francesca Bursi
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Insights
Patients with myocardial infarction (MI) identified solely by troponin criteria exhibit better systolic function and a lower risk of developing heart failure (HF) compared to those meeting creatine kinase-MB (CK-MB) criteria.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Diagnostics
Background:
- The 2000 MI definition allowed for MI identification based on troponin-only criteria.
- Limited data exists on ventricular function and heart failure (HF) in patients identified solely by troponin.
- This gap necessitates further investigation into the clinical implications of troponin-only MI.
Purpose of the Study:
- To compare ventricular function and the incidence of heart failure (HF) in myocardial infarction (MI) patients.
- To differentiate outcomes between patients meeting troponin-only criteria versus creatine kinase-MB (CK-MB) criteria for MI diagnosis.
Main Methods:
- Prospective identification of 835 MI patients using standardized criteria (cardiac pain, ECG, biomarkers) from 2002-2006.
- Measurement of troponin and CK-MB in all patients; classification based on criteria met.
- Echocardiograms performed on 482 patients; 1-year follow-up for HF development.
Main Results:
- Patients meeting only troponin criteria (n=119) had a lower wall motion score index than CK-MB criteria patients (n=363) (P<.01).
- Diastolic function was comparable between groups.
- After 1 year, patients meeting only troponin criteria had a significantly lower risk of developing post-MI HF (HR 0.56; P<.01), even after adjusting for systolic/diastolic function.
Conclusions:
- The updated MI definition identifies patients with troponin-only MI who have superior systolic function compared to CK-MB criteria MI.
- These troponin-only MI patients demonstrate a reduced risk of subsequent heart failure.
- Findings support the use of these criteria for improved risk stratification in clinical practice.
Objectives:
The aim of this study is to evaluate ventricular function and the occurrence of heart failure (HF) among persons with myocardial infarction (MI) meeting only troponin criteria compared to persons meeting creatine kinase and its MB fraction (CK-MB) criteria.
Background:
The 2000 American College of Cardiology/European Society of Cardiology MI definition enabled identification of MIs meeting only troponin-based criteria. Data on ventricular function and HF among these are lacking.
Methods:
Between November 2002 and May 2006, we prospectively identified 835 persons with MI in the community using standardized criteria including cardiac pain, electrocardiogram, and biomarkers. Troponin and CK-MB were prospectively measured in all; each patient was classified according to the criteria met.
Results:
We performed echocardiograms (median of 1 day post-MI) in 482 patients (age 68+/-15 years; 45% women); 363 patients met CK-MB criteria, whereas 119 met only troponin criteria. The latter had lower wall motion score index (1.3+/-0.4 vs 1.5+/-0.5 for CK-MB; P<.01). Diastolic dysfunction was similar in both groups. After 1 year of follow up, 142 patients developed post-MI HF. Patients meeting only troponin criteria had a lower risk of HF after adjustment for age, sex, comorbidity (hazard ratio 0.56, 95% confidence interval 0.37-0.85, P<.01), which persisted after further adjustments for systolic or diastolic function.
Conclusions:
In the community, the prospective application of the new MI definition identifies patients meeting only troponin criteria with better systolic function than cases meeting CK-MB criteria. Such MIs have a lower risk of subsequent HF. These findings are important for risk stratification in clinical practice.
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