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Prognostic Value of LVEDP in Acute Myocardial Infarction: a Systematic Review and Meta-Analysis
Stephen C Brienesse1,2, Allan J Davies2,3, Arshad Khan2,3,4
1Department of General Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
Insights
Elevated left ventricular end-diastolic pressure (LVEDP) in acute myocardial infarction patients predicts increased risk of death and heart failure. This easily measured pressure is a valuable prognostic tool for guiding therapy and assessing patient outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Cardiovascular Research
Background:
- Left ventricular end-diastolic pressure (LVEDP) is a key indicator of overall left ventricular function.
- LVEDP can be readily measured during cardiac catheterization.
- Its prognostic value in acute myocardial infarction (AMI) warrants further investigation.
Purpose of the Study:
- To evaluate the utility of LVEDP as a prognostic marker in patients presenting with acute myocardial infarction.
- To determine if elevated LVEDP predicts adverse outcomes post-AMI.
Main Methods:
- A comprehensive literature search was conducted across electronic databases from 1946 to March 2017.
- Studies included patients with acute coronary syndrome and LVEDP measurements via cardiac catheterization, with reported major adverse cardiac events.
- Data extraction and quality assessment were performed independently by two reviewers using established tools.
Main Results:
- Seven studies involving 8637 patients were analyzed.
- Elevated LVEDP in ST-elevation myocardial infarction (STEMI) patients significantly increased the risk of 30-day mortality (RR 1.9) and heart failure (RR 2.9).
- No significant increase in 30-day reinfarction risk was observed (RR 1.25).
Conclusions:
- Elevated LVEDP during cardiac catheterization for AMI is a significant predictor of subsequent heart failure and mortality.
- LVEDP serves as a valuable prognostic indicator for risk stratification and guiding treatment in AMI patients.
- Further research may refine the role of LVEDP in managing post-myocardial infarction complications.
Abstract:
Left ventricular end-diastolic pressure (LVEDP) is an easily obtained, physiologically integrative measure of total LV function. LVEDP may be a useful prognostic measure in patients with acute myocardial infarction and utilised to guide medical therapy and assess risk for post myocardial infarction heart failure. To assess the utility of LVEDP as a prognostic measure in patients presenting with acute myocardial infarction. We performed an unrestricted search of electronic databases (1946 to March 2017) using a predefined search strategy. Publications were included if patients had an acute coronary syndrome and LVEDP was measured by cardiac catheterisation and included outcome data specifying major adverse cardiac events. Two reviewers performed independent study selection, data abstraction and quality assessment by using the Cochrane tool for randomised trials and the ROBINS-I tool for non-randomised studies. Our search identified 8637 patients in seven studies. In patients with elevated LVEDP and STEMI, there was a significantly increased risk of 30-day death (three studies, 5372 participants; RR 1.9; 95% CI 1.4-2.7; p < 0.001; I 2 = 35.3%) and heart failure (two studies, 2574 participants; RR 2.9; 95% CI 1.9-4.5; p = < 0.001; I 2 = 0.0%). There was no significant increase in risk of 30 day reinfarction (RR 1.25; 95% CI 0.77-2.1; p = 0.37; I 2 = 41.3%). Elevated LVEDP measured during cardiac catheterisation for acute myocardial infarction appears to be a predictor of heart failure and mortality.
