Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without
Mustafa Kacmaz1,2, Clara Schlettert3, Fabienne Kreimer4
1Institute of Physiology, Department of Cellular and Translational Physiology and Institute für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, 44791 Bochum, Germany.
Insights
Lower left ventricular ejection fraction (LVEF) in patients with myocardial infarction and non-obstructive coronary artery disease (MINOCA) is linked to worse in-hospital outcomes and increased long-term mortality. This highlights LVEF as a critical factor in MINOCA prognosis.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Myocardial infarction with non-obstructive coronary artery disease (MINOCA) pathophysiology and clinical course remain incompletely understood.
- Existing research lacks comprehensive analysis of MINOCA patient outcomes stratified by left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To investigate the baseline characteristics, in-hospital, and long-term outcomes of troponin-positive patients with MINOCA.
- To analyze these outcomes across different categories of left ventricular ejection fraction (LVEF).
Main Methods:
- Retrospective analysis of 254 troponin-positive MINOCA patients (2010-2021).
- Patients categorized by LVEF: ≥50%, 40-49%, and <40%.
- Comparison of baseline characteristics, in-hospital events, and long-term all-cause mortality across LVEF groups.
Main Results:
- Patients with LVEF <40% exhibited the highest mean troponin and BNP levels, and the highest rates of in-hospital cardiovascular events (56%).
- In-hospital cardiovascular events were significantly higher in LVEF <40% (56%) and LVEF 40-49% (55%) groups compared to LVEF ≥50% (27%).
- Lower LVEF (<40% and 40-49%) was independently associated with increased risk of in-hospital cardiovascular events.
Conclusions:
- Left ventricular ejection fraction significantly impacts in-hospital cardiovascular event rates in MINOCA patients.
- LVEF is a crucial determinant influencing long-term all-cause mortality in the MINOCA population.
Abstract:
Background: The development and course of myocardial infarction with non-obstructive coronary artery (MINOCA) disease is still not fully understood. In this study, we aimed to examine the baseline characteristics of in-hospital outcomes and long-term outcomes of a cohort of troponin-positive patients without obstructive coronary artery disease based on different left ventricular ejection fractions (LVEFs). Methods and results: We included a cohort of 254 patients (mean age: 64 (50.8-75.3) years, 120 females) with suspected myocardial infarction and no obstructive coronary artery disease (MINOCA) in our institutional database between 2010 and 2021. Among these patients, 170 had LVEF ≥ 50% (84 females, 49.4%), 31 patients had LVEF 40-49% (15 females, 48.4%), and 53 patients had LVEF < 40% (20 females, 37.7%). The mean age in the LVEF ≥ 50% group was 61.5 (48-73) years, in the LVEF 40-49% group was 67 (57-78) years, and in the LVEF < 40% group was 68 (56-75.5) years (p = 0.05). The mean troponin value was highest in the LVEF < 40% group, at 3.8 (1.7-4.6) µg/L, and lowest in the LVEF ≥ 50% group, at 1.1 (0.5-2.1) µg/L (p = 0.05). Creatine Phosphokinase (CK) levels were highest in the LVEF ≥ 50% group (156 (89.5-256)) and lowest in the LVEF 40-49% group (127 (73-256)) (p < 0.05), while the mean BNP value was lowest in the LVEF ≥ 50% group (98 (48-278) pg/mL) and highest in the <40% group (793 (238.3-2247.5) pg/mL) (p = 0.001). Adverse in-hospital cardiovascular events were highest in the LVEF < 40% group compared to the LVEF 40-49% group and the LVEF ≥ 50% group (56% vs. 55% vs. 27%; p < 0.001). Over a follow-up period of 6.2 ± 3.1 years, the all-cause mortality was higher in the LVEF < 40% group compared to the LVEF 40-49% group and the LVEF ≥ 50% group. Among the different factors, LVEF < 40% and LVEF 40-49% were associated with an increased risk of in-hospital cardiovascular events in the multivariable Cox regression analysis. Conclusions: LVEF has different impacts on in-hospital cardiovascular events in this cohort. Furthermore, LVEF influences long-term all-cause mortality.
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