Long-term heart function in cardiac-arrest survivors
Jean-Herlé Raphalen1, Tal Soumagnac1, Marc Delord2,3
1Intensive Care Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
Insights
Most cardiac arrest survivors had no heart failure symptoms one year post-event. Absence of bystander CPR was linked to worse functional class, and nearly a third experienced major adverse cardiovascular events.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Outcomes Research
Background:
- Cardiac arrest (CA) survivors often face long-term myocardial dysfunction.
- Assessing functional recovery and adverse events post-CA is crucial for patient management.
Purpose of the Study:
- To evaluate long-term myocardial dysfunction outcomes after cardiac arrest of cardiac origin.
- To identify predictors of functional class and major adverse cardiovascular events (MACE) at one year.
Main Methods:
- Retrospective analysis of adult patients surviving CA of cardiac origin (2005-2019).
- Primary endpoints included 1-year New York Heart Association Functional Class (NYHA-FC) and MACE.
- Echocardiographic data and follow-up events were analyzed.
Main Results:
- 80% of patients had NYHA-FC I at 1 year; 18% had NYHA-FC II.
- Left ventricular ejection fraction improved but remained abnormal in 33% at 6 months.
- 32% experienced MACE, primarily acute heart failure or ischemic events; pre-CA disease and lack of bystander CPR were risk factors.
Conclusions:
- Most CA survivors exhibit minimal heart failure symptoms at one year.
- Absence of bystander CPR was a significant predictor of poorer 1-year functional outcomes.
- Left ventricular dysfunction showed partial recovery within six months for many patients.
Purpose:
To assess outcomes and predictors of long-term myocardial dysfunction after cardiac arrest (CA) of cardiac origin.
Methods:
We retrospectively included consecutive, single-center, prospective-registry patients who survived to hospital discharge for adult out-of-hospital and in-hospital CA of cardiac origin in 2005-2019. The primary objective was to collect the 1-year New York Heart Association Functional Class (NYHA-FC) and major adverse cardiovascular events (MACE).
Results:
Of 135 patients, 94 (72%) had their NYHA-FC determined after 1 year, including 75 (75/94, 80%) who were I, 17 (17/94, 18%) II, 2 (2/94, 2%) III, and none IV. The echocardiographic left ventricular ejection fraction was abnormal in 87/130 (67%) patients on day 1, 52/123 (42%) at hospital discharge, and 17/52 (33%) at 6 months. During the median follow-up of 796 [283-1975] days, 38/119 (32%) patients experienced a MACE. These events were predominantly related to acute heart failure (13/38) or ischemic cardiovascular events (16/38), with acute coronary syndrome being the most prevalent among them (8/16). Pre-CA cardiovascular disease was a risk factor for 1-year NYHA-FC > I (P = 0.01), absence of bystander cardiopulmonary resuscitation was significantly associated with NYHA-FC > I at 1 year.
Conclusion:
Most patients had no heart-failure symptoms a year after adult out-of hospital or in-hospital CA of cardiac origin, and absence of bystander cardiopulmonary resuscitation was the only treatment component significantly associated with NYHA-FC > I at 1 year. Nearly a third experienced MACE and the most common types of MACE were ischemic cardiovascular events and acute heart failure. Early left ventricular dysfunction recovered within 6 months in half the patients with available values.
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