Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy
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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
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.
