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Updated: Feb 27, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for
Rona Reibis1, Annett Salzwedel2, Klaus Bonaventura3
1Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany.
Insights
Revascularization moderately improves left ventricular ejection fraction (LVEF) in heart failure patients post-myocardial infarction (MI). High variability means single LVEF measurements may not reliably guide cardioverter-defibrillator (ICD) decisions.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Reduced left ventricular ejection fraction (LVEF) ≤30% post-myocardial infarction (MI) is a key indicator for sudden cardiac death (SCD).
- Limited data exist on long-term LVEF changes after revascularization and cardioverter-defibrillator (ICD) implantation.
Purpose of the Study:
- To investigate long-term changes in LVEF after revascularization in patients with reduced LVEF post-MI.
- To assess the reliability of LVEF measurements in guiding ICD indications.
Main Methods:
- Retrospective analysis of 277 patients with LVEF ≤40% at least 1 month post-MI and complete revascularization (PCI or CABG).
- Patients were grouped by LVEF (<30% or 30-40%).
- Biplane echocardiography was performed at baseline and after a mean follow-up of 441 days.
Main Results:
- LVEF significantly increased in both groups (p < 0.001).
- Mean LVEF showed a moderate increase from 35% to 37% (p < 0.001) after accounting for regression toward the mean.
- A large interindividual variation in LVEF changes was observed.
Conclusions:
- Early revascularization has a limited impact on LVEF in most post-MI heart failure patients.
- The significant variability in LVEF changes suggests that a single measurement may be insufficient for ICD indication decisions.
Background:
Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD).
Methods:
We performed a retrospective analysis of 277 patients with reduced LVEF at least 1 month after MI and complete revascularization. Patients (median time post-MI 23.4 months; 74.3% after PCI, 25.7% after CABG were assigned either to group 1 (LVEF <30%) or group 2 (LVEF 30-40%). Biplane echocardiography was redone after a mean follow-up of 441 ± 220 days.
Results:
LVEF increased significantly in both two groups (group 1: 26.2 ± 4.8% to 32.4 ± 8.5%; p < 0.001; group 2: 38.2 ± 2.5% to 44.4 ± 9.6%; p < 0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37% (p < 0.001) with a large interindividual variation.
Conclusions:
The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.
