Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction.

Abstract

Impairment of left ventricular function is the major predictor of mortality after acute myocardial infarction, but it is not known whether this is best described by ejection fraction or by endsystolic or end-diastolic volume. We measured volumes, ejection fractions, and severity of coronary arterial occlusions and stenoses in 605 male patients under 60 years of age at 1 to 2 months after a first (n = 443) or recurrent (n = 162) myocardial infarction and followed these patients for a mean of 78 months for survivors (range 15 to 165 months). There were 101 cardiac deaths, 71 (70%) of which were sudden (instantaneous or found dead). Multivariate analysis with log rank testing and the Cox proportional hazards model showed that end-systolic volume (X2 = 82.9) had greater predictive value for survival than end-diastolic volume (X2 = 59.0) or ejection fraction (X2 = 46.6), whereas stepwise analysis showed that once the relationship between survival and end-systolic volume had been fitted, there was no additional significant predictive information in either end-diastolic volume or ejection fraction. Severity of coronary occlusions and stenoses showed additional prediction of only borderline significance (p = .04 in one analysis), but continued cigarette smoking did remain an independent risk factor after stepwise analysis. For a subset of patients (n = 200) who had taken part in a randomized trial of coronary artery surgery after recovery from infarction, surgical "intention to treat" showed no predictive value. We conclude that for prediction, end-systolic volume is the primary predictor of survival after myocardial infarction, being superior to ejection fraction when ejection fraction is low (<50%) or when end-systolic volume is high (< 100 ml). Treatment of infarction should be aimed at limitation of infarct size and prevention of ventricular dilation.Circulation 76, No. 1, 44-51, 1987. IT IS NOW RECOGNIZED that the major predictor of long-term survival after recovery from acute myocardial infarction is the functional status of the left ventricle. Left ventricular function has usually been described in terms of the ejection fraction (EF),1-4 but it is not clear whether EF is the most meaningful index of left ventricular function in the postinfarction situation. Low EF may, on the one hand, be caused by poor contractile function due to extensive myocardial damage or continuing ischemia or, on the other hand, to left ventricular dilation caused by infarct expansion and stretching of the myocardial scar. Thus end-systolic volume (ESV) or end-diastolic volume (EDV) might be more meaningful predictors of prognosis than

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

“…This review will predominantly focus on three indices; outcome-based metrics which evaluate survival and mortality after device implantation. Markers of left ventricular reverse remodeling (LVRR) following device implantation, of which a reduction in LV end-systolic volume (LVESV) is the most widely accepted marker [26,27]. Finally, some metrics evaluate acute changes in LV contractility.…”

The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

“…Previous history of hypertension, which is a major determinant of the ventricular afterload, is a strong predictor of infarct expansion, 10 which in turn is directly related to increased mortality and heart failure morbidity. 21 ACE inhibition prevents or attenuates infarct expansion 22 and thus would be expected to be particularly advantageous in hypertensive patients.…”

Predictive value of the serum level of N‐terminal pro‐brain natriuretic peptide and high‐sensitivity C‐reactive protein in left ventricular remodeling after acute myocardial infarction

“…Although modern treatments have greatly improved the life span of patients with AMI, left ventricular (LV) remodeling is still a detrimental complication in AMI that contributes to a poor survival rate in clinical practice (1). If LV remodeling could be diagnosed at an early stage, appropriate therapeutic tactics could be selected to improve the long-term remodeling prognosis.…”