Patterns of Left-Ventricular Function Assessment in Patients With Acute Coronary Syndromes
Daniel Malebranche1, Sarah Hasan2, Marinda Fung2
1Arthur J.E. Child Fellow, Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Insights
Patients with acute coronary syndromes (ACS) often have repeated left-ventricular ejection fraction (LVEF) tests. Most patients with normal LVEF rarely see a significant drop, suggesting fewer tests could improve care quality.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Assessment
Background:
- Current guidelines recommend left-ventricular ejection fraction (LVEF) assessment in acute coronary syndromes (ACS).
- The clinical utility of serial LVEF assessments in ACS patients remains unclear.
- This study investigates the value of repeated LVEF measurements in ACS.
Purpose of the Study:
- To evaluate the clinical significance of serial left-ventricular ejection fraction (LVEF) assessments in patients with acute coronary syndromes (ACS).
- To determine the rate of LVEF decline in ACS patients with preserved or mildly reduced LVEF.
- To inform potential reductions in low-value cardiac testing.
Main Methods:
- Retrospective analysis of 8327 ACS patients undergoing cardiac catheterization (2012-2016).
- Subsample (n=3221) with available echocardiograms analyzed for LVEF changes over time.
- Patients categorized into three groups based on initial LVEF: >50%, 35%-50%, and <35%.
Main Results:
- 66% of ACS patients presented with LVEF >50%, 27% with LVEF 35%-50%, and 7% with LVEF <35%.
- Over an average follow-up of 2.71 years, only 1.1% of patients with initially preserved LVEF (>50%) and 5.1% with mildly reduced LVEF (35%-50%) declined to LVEF <35%.
- More than half of the cohort (n=4600) had follow-up LV function assessments.
Conclusions:
- Serial LVEF assessments in ACS patients with initially preserved or mildly reduced function are infrequently associated with significant decline.
- The findings suggest that frequent LVEF testing in certain ACS patient groups may represent low-value care.
- Reducing unnecessary cardiac tests could enhance the quality of care for ACS patients.
Background:
In patients with acute coronary syndromes (ACS), guidelines recommend the assessment of left-ventricular ejection fraction (LVEF). Many patients with ACS undergo multiple assessments of LVEF, the clinical value of which is unknown.
Methods:
Patients with ACS undergoing cardiac catheterization between 2012 and 2016 were evaluated and assessments of LV function identified. To evaluate changes in LVEF over time, available echocardiograms were reviewed in a subsample of patients with LVEF data available (n = 3221). Patients with ACS were classified into 3 groups: group 1 (LVEF > 50%), group 2 (LVEF 35% to 50%), and group 3 (LVEF < 35%).
Results:
Our cohort consisted of 8327 patients with ACS (76% men), presenting with a mean age of 62.4 ± 12.4 years. At index presentation, 66% of patients had an LVEF > 50%, 27% had an LVEF between 35% and 50%, and 7% had severely reduced LVEF of < 35%. More than half of the cohort (n = 4600) had follow-up assessment of LV function, performed over an average of 2.71 ± 1.31 years. In the subsample of 3221 patients, only 1.1% of those in group 1, and 5.1% of those in group 2, deteriorated to an LVEF < 35%.
Conclusions:
Patients with ACS often undergo multiple assessments of LV function. Those with initially preserved EF rarely demonstrate a decline in EF to < 35%. A reduction in low-value cardiac tests may be an important first step in improving the quality of care for patients with ACS.
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