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Preserved or slightly depressed ejection fraction and outcomes after myocardial infarction
  1. Apurva O Badheka1,
  2. Ankit Rathod1,
  3. Aditya S Bharadwaj1,
  4. Palaniappan Manickam1,
  5. Mohammad A Kizilbash1,2,
  6. Vikas Veeranna1,2,
  7. Sony Jacob1,2,
  8. Luis Afonso1,2
  1. 1Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
  2. 2Division of Cardiology, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Luis Afonso, Division of Cardiology, 8 Brush, Harper University Hospital, Division of Cardiology, Wayne State University, 3990 John R, Detroit, MI 48201, USA; lafonso{at}med.wayne.edu

Abstract

Background Left ventricular ejection fraction (EF) in post-myocardial infarction (MI) patients is a strong predictor of adverse cardiovascular events. Although resting EF as measured by transthoracic echocardiography (TTE), contrast ventriculography (CNV), and radionuclide angiography (RNA) exhibit high correlation, there is only modest agreement between these modalities. This study sought to explore whether modality of EF assessment influences prognostication of post-MI patients with normal or slightly reduced EF.

Methods and results The National Heart, Lung, and Blood Institute (NHLBI) limited access dataset of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial (1996–2003, n=8290) comparing trandolapril versus placebo was used. The cohort was partitioned into TTE (n=2582), RNA (n=816), and CNV (n=1155) groups based on modality of EF assessment. EF was a significant predictor of cardiovascular mortality (HR 0.97, 95% CI 0.95 to 0.98; p<0.005) and all cause mortality (HR 0.98, 95% CI 0.97 to 0.99; p=0.0002) on multivariate analysis in this population with preserved or mildly depressed EF. Although CNV, TTE, and RNA groups differed significantly in terms of baseline variables, no appreciable differences were noted between RNA (HR 1.13, 95% CI 0.85 to 1.50; ns) and CNV (HR 1.13, 95% CI 0.99 to 1.27; ns) groups, compared with TTE for all cause mortality. Similarly, no significant differences were observed for cardiovascular mortality between RNA (HR 1.23, 95% CI 0.82 to 1.84; p=0.31) and CNV (HR 1.14, 95% CI 0.78 to 1.67, p=0.49) versus TTE.

Conclusion EF is a significant predictor of all-cause mortality and cardiovascular mortality in patients with preserved or mildly depressed EF. Modalities of EF measurement are interchangeable and do not play a significant role in prognostication in a post-MI population.

  • Echocardiography
  • heart failure
  • myocardial infarction

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Footnotes

  • Disclosures The study results were part of an oral presentation at the 20th Annual Scientific Sessions of the American Society of Echocardiography 2009 at Washington, DC. None of the authors are affiliated with the NHLBI or the PEACE trial

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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