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[Acute heart failure and early development of left ventricular dysfunction in patients with ST segment elevation
J Parenica1, P Kala, J Jarkovský
1Interní kardiologická klinika Lékarské fakulty MU a FN Brno. jiri.parenica@atlas.cz
Insights
Acute heart failure (AHF) affects one-third of ST-elevation myocardial infarction (STEMI) patients, increasing mortality risk. Higher blood sugar, heart rate, anterior MI, and age are key predictors of AHF and left ventricular dysfunction.
Area of Science:
- Cardiology
- Internal Medicine
- Biomedical Science
Context:
- Acute heart failure (AHF) significantly worsens prognosis in patients experiencing ST-elevation myocardial infarction (STEMI).
- Early identification of factors predicting AHF and left ventricular dysfunction is crucial for improving patient outcomes.
- This study prospectively evaluates patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Purpose:
- To identify independent predictors of acute heart failure (AHF) in STEMI patients.
- To determine factors associated with early left ventricular dysfunction following STEMI.
- To analyze the relationship between baseline patient characteristics, biomarkers, and AHF development.
Summary:
- A cohort of 593 STEMI patients (164 with AHF) treated with primary PCI was studied.
- Biomarkers (BNP, NT-ProBNP), echocardiography, and left ventricular angiography were utilized.
- Independent predictors for AHF and left ventricular dysfunction included higher glucose levels, age, heart rate, and anterior wall MI; lower aortic pulse pressure was associated with reduced risk.
Impact:
- AHF was observed in one-third of STEMI patients, with mortality risk escalating with failure severity.
- Findings highlight the prognostic significance of AHF and identify key modifiable and non-modifiable risk factors.
- Establishing cut-off values for LVEDP, dP/dt/P, glycaemia, and aortic pulse pressure aids in AHF risk stratification.
Background:
Acute heart failure during ST elevation myocardial infarction (STEMI) makes worse prognosis. The aim of the work was to find independent factors with relationship to acute heart failure (AHF) and the early development of left ventricular dysfunction within the prospective followed patients with STEMI.
Methods:
A total of 593 patients with STEMI treated by primary PCI (164 patients with AHF) were the study population. The activity of BNP and NT-ProBNP were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI.
Results:
The patients with AHF had higher level of glycaemia, creatinine, uric acid, HDL-cholesterol, leukocytosis and natriuretic peptid. The total hospital mortality was 3.7%. 0.2% within the patients without AHF, 3.2%, 14.3%, resp. 63.6% within the patients with mild AHF, with pulmonary oedema, resp. with cardiogenic shock. The patients with AHF had lower ejection fraction (45.4 +/- 11.9% vs 53.0 +/- 10.3%). According to the multiple logistic regression we found higher glycaemia, age, heart rate, anterior wall MI, lower aortic pulse pressure and collaterals of infarct related artery as factors with independent relationship to AHF. Higher glycaemia, age, heart rate, anterior wall MI and lower aortic pulse pressure were found as independent factors with relationship to left ventricular dysfunction. According to ROC analysis possible cut off corresponding with AHF we suggested 29.5 mm Hg for LVEDP, 28.5 for dP/dt/P, 9.5 mmol/l for glycaemia, 50 mm Hg for aortic pulse pressure.
Conclusions:
Our results found the development of AHF in one third of patients with STEMI. AHF increases the risk of in-hospital mortality and the risk depends upon severity of failure. As the independent factors with relationship to development of AHF or left ventricular dysfunction we detected higher glycaemia, heart rate, anterior wall MI, age. Lower risk had patients with higher aortic pulse pressure.
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