Prognostic Value of Left Ventricular End-Diastolic Pressure in Patients With Non-ST-Segment Elevation Myocardial
Akihiro Kobayashi1, Naoki Misumida1, John T Fox2
1Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
Insights
Elevated left ventricular end-diastolic pressure (LVEDP) predicts higher mortality in non-ST-segment elevation myocardial infarction (NSTEMI) patients. A cutoff of 22 mm Hg identified those at increased risk for heart failure and death.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Elevated left ventricular end-diastolic pressure (LVEDP) is a known mortality predictor in ST-segment elevation myocardial infarction.
- The prognostic significance of LVEDP in non-ST-segment elevation myocardial infarction (NSTEMI) is not well-established.
Purpose of the Study:
- To investigate the prognostic value of LVEDP in predicting in-hospital mortality and heart failure in NSTEMI patients.
Main Methods:
- Retrospective analysis of 367 NSTEMI patients undergoing coronary angiography.
- Exclusion of patients without LVEDP measurements.
- Recording of baseline, angiographic characteristics, in-hospital heart failure, and mortality.
Main Results:
- An LVEDP cutoff of 22 mm Hg optimally predicted in-hospital mortality (AUC 0.80).
- Patients with LVEDP > 22 mm Hg (29.7%) had significantly higher rates of in-hospital heart failure (22.0% vs. 13.2%) and mortality (3.7% vs. 0.4%).
- Higher LVEDP was associated with more comorbidities but not multi-vessel disease.
Conclusions:
- Elevated LVEDP is a significant independent predictor of in-hospital mortality in NSTEMI patients.
- LVEDP measurement can aid risk stratification in NSTEMI.
Background:
Elevated left ventricular end-diastolic pressure (LVEDP) has been reported to predict an increased mortality in patients with ST-segment elevation myocardial infarction. However, its prognostic value in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.
Methods:
We performed a retrospective analysis of NSTEMI patients who underwent coronary angiography between January 2013 and June 2014. We excluded patients who did not undergo LVEDP measurements. Baseline and angiographic characteristics, in-hospital heart failure as well as in-hospital mortality were recorded.
Results:
After exclusion, 367 patients were included in the final analysis. The median (interquartile range) LVEDP was 19 mm Hg (14 - 24 mm Hg). By receiver operating characteristic curve analysis, the optimal cutoff value for predicting in-hospital mortality was 22 mm Hg (area under the curve 0.80, sensitivity 80%, and specificity 71%). Of 367 patients, 109 patients (29.7%) had LVEDP > 22 mm Hg. Patients with LVEDP > 22 mm Hg had a greater number of comorbidities. There was no statistically significant difference in the rate of multi-vessel disease. Patients with LVEDP > 22 mm Hg had a significantly higher rate of in-hospital heart failure (22.0% vs. 13.2%, P = 0.03) and in-hospital mortality (3.7% vs. 0.4%, P = 0.03) than those with LVEDP ≤ 22 mm Hg.
Conclusion:
Elevated LVEDP was significantly associated with a higher in-hospital mortality in patients with NSTEMI.
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