Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea.
Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea Seoul Republic of Korea.
J Am Heart Assoc. 2024 Aug 20;13(16):e034920. doi: 10.1161/JAHA.124.034920. Epub 2024 Aug 19.
Little is known about the characteristics and long-term clinical outcomes of patients with heart failure with improved ejection fraction (HFimpEF) after acute myocardial infarction.
From a multicenter, consecutive cohort of patients with acute myocardial infarction undergoing percutaneous coronary intervention, patients with an initial echocardiogram with left ventricular ejection fraction ≤40% and at least 1 follow-up echocardiogram after 14 days and within 2 years of the initial event were considered for analyses. HFimpEF was defined as an initial left ventricular ejection fraction ≤40% and serial left ventricular ejection fraction >40% with an increase of ≥10% from baseline at follow-up. Independent factors predicting HFimpEF were identified, and clinical outcomes of patients with HFimpEF were compared with those without improvement. From an initial cohort of 10 719 patients with acute myocardial infarction, 191 patients with HFimpEF and 256 patients with non-HFimpEF who had initial and follow-up echocardiographic data were analyzed. The median follow-up duration was 4.5 (interquartile range, 2.9-5.0) years. The factors predicting HFimpEF were lower peak creatine kinase myocardial band, smaller left ventricular dimensions, lower ratio between early mitral inflow velocity and mitral annular early diastolic velocity ', and the use of β blockers or renin-angiotensin system blockers at discharge. HFimpEF was associated with a significantly decreased risk of all-cause death compared with non-HFimpEF (hazard ratio, 0.377 [95% CI, 0.234-0.609]; <0.001). In 2-year landmark analysis, these findings were consistent not only before but also after the landmark point. Similar findings were true for cardiovascular death and admission for heart failure.
Patients with HFimpEF after acute myocardial infarction showed distinct clinical and echocardiographic characteristics and were associated with better long-term clinical outcomes.
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02806102.
对于急性心肌梗死后射血分数改善的心力衰竭（HFimpEF）患者的特征和长期临床结局知之甚少。
入选了一项多中心、连续的经皮冠状动脉介入治疗急性心肌梗死患者队列，入选标准为初始超声心动图左心室射血分数（LVEF）≤40%，且在初始事件后 14 天内和 2 年内至少有 1 次随访超声心动图。HFimpEF 的定义为初始 LVEF≤40%，随访时 LVEF>40%，且与基线相比增加≥10%。确定了预测 HFimpEF 的独立因素，并比较了 HFimpEF 患者与未改善患者的临床结局。入选了初始队列中 10719 例急性心肌梗死患者，其中 191 例患者为 HFimpEF，256 例患者为非 HFimpEF，这些患者有初始和随访超声心动图数据。中位随访时间为 4.5（四分位距，2.9-5.0）年。预测 HFimpEF 的因素包括肌酸激酶同工酶峰值较低、左心室尺寸较小、E 峰与二尖瓣环早期舒张速度比值较低，以及出院时使用β受体阻滞剂或肾素-血管紧张素系统阻滞剂。与非 HFimpEF 相比，HFimpEF 患者的全因死亡风险显著降低（风险比，0.377[95%置信区间，0.234-0.609]；<0.001）。在 2 年的时间节点分析中，这些发现不仅在时间节点之前，而且在时间节点之后也是一致的。对于心血管死亡和心力衰竭入院，也有类似的发现。
急性心肌梗死后出现 HFimpEF 的患者具有明显的临床和超声心动图特征，与更好的长期临床结局相关。
