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Predicting Left Ventricular Dysfunction After MI
Study Questions:
What clinical factors predict improvement of left ventricular (LV) function to >35% and ≥50% after 90 days following acute myocardial infarction (MI)?
Methods:
A total of 231 patients with ejection fraction (EF) ≤35% at the time of MI were enrolled in the PREDICTS (PREDiction of ICd Treatment Study) trial and followed prospectively. Predictors for EF recovery were identified with multivariate modeling and validated in a separate cohort (n = 236).
Results:
About 43% of patients had persistent EF ≤35%, 31% had an EF of 36-49%, and 26% had an EF ≥50%. The model that best predicted recovery of EF to EF ≥50% included EF at presentation, peak troponin, prior MI, and presentation with ventricular fibrillation or cardiac arrest. After predictions were transformed into point scores, the lowest point scores predicted a 9% and 4% probability of EF recovery to >35% and ≥50%, whereas profiles with the highest point scores predicted an 87% and 49% probability of EF recovery to >35% and ≥50%. Point score included EF at MI presentation, length of stay, history of MI, lateral wall motion abnormality, troponin max fold increase, and presentation with ventricular fibrillation or cardiac arrest.
Conclusions:
In patients with severe systolic dysfunction following acute MI with an EF ≤35%, 57% had EF recovery to >35%.
Perspective:
A prior study (DINAMIT) showed that prophylactic implantation of an implantable cardioverter-defibrillator (ICD) within 40 days of acute MI did not reduce mortality as a significantly reduced arrhythmic death was offset by a significant increase in nonarrhythmic death. Nonetheless, there may be a subgroup of patients who benefit from early implantation of ICD. The ability to predict lack of LV function recovery, among other factors, could help identify this group. Prospective studies would be needed to determine whether ICD implantation in these patients improves survival.
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Defibrillators, Implantable, Heart Arrest, Heart Failure, Myocardial Infarction, Secondary Prevention, Stroke Volume, Troponin, Ventricular Dysfunction, Left, Ventricular Fibrillation
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