Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction.

Abstract

SUMMARY To assess the prognostic importance of resting left ventricular function in survivors of acute myocardial infarction with pulmonary edema, we retrospectively identified 39 consecutive patients who presented with acute pulmonary edema and myocardial infarction. Sixteen patients had radionuclide ejection fractions 10 2 days postinfarction of > 0.45 (group A, mean 0.55 0.06), and 23 patients had ejection fractions S 0.45 (group B, 0.32 + 0.06). There were no significant differences between the two groups for age or sex, but group A patients had a significantly greater incidence of first myocardial infarction predominantly inferior in location. The calculated stroke work index during the acute event was significantly greater in group A than in group B (33.4 + 2.4 vs 23.4 + 2.0) (p < 0.05). During a follow-up of 9 3 months, mortality was not significantly different between the two groups: Four (25%) died in group A and seven (30%) died in group B. In addition, eight patients (50%) in group A were hospitalized for recurrent angina, new myocardial infarction or recurrent pulmonary edema, compared with 11 (48%) in group B (NS). Three deaths in group A were preceded by infarction of the anterior wall of the left ventricle, confirmed at autopsy, and two nonfatal infarctions were anterior by electrocardiography. Four patients in group A had coronary arteriography performed during the follow-up period because of unstable angina, and all had significant (Dr 70% stenosis) three-vessel disease and two had left main coronary artery disease. Therefore, the predischarge ejection fraction did not predict prognosis for this group of patients.Patients with acute pulmonary edema in the course of myocardial infarction form a high-risk group despite good resting left ventricular function at discharge. They have a significant incidence of recurrent myocardial infarction and death and, because they have good residual left ventricular function, are excellent candidates for surgical intervention.THE EARLY and late prognoses for acute myocardial infarction are adversely affected by the occurrence of left ventricular failure. 1-3 The manifestation of acute pulmonary edema is particularly lethal.' 4, 10 Presumably, pulmonary edema reflects the severity and extent of acute and chronic abnormalities in left ventricular contraction. Thus, pulmonary edema is more common in patients with a history of infarction and in patients with large initial infarctions, which are usually anterior wall infarctions. It is not surprising that in a study by Schelbert et al.,14 measuring radionuclide ejection fractions after myocardial infarction, patients with pulmonary edema had severely depressed ejection fractions and no patient had a normal ejection fraction (> 0.52).Since January 1980, we have routinely obtained a predischarge radionuclide angiocardiogram for all survivors of acute myocardial infarction. It became apparent that certain patients who had manifested pulmonary edema had an unexpectedly normal or only mildly depressed ejection fraction at...

Risk Stratification after Acute Myocardial Infarction by Means of Echocardiographic Wall Motion Scoring and Killip Classification

“…but the 1-vear mortality increased significantly with increasing Killip class (table 1), suggest ing that patients in the worst Killip class (III and IV) are at higher risk than patients in Kil lip class II despite the lack of difference in WMI on day 5. This is in accordance with pre vious studies, where patients with severe clin ical heart failure in the course of AMI formed a high risk group, despite the finding of a good resting LVEF at the time of discharge [22,23]. The patients with a good resting LVEF who present themselves in Killip class III or IV might be patients with remote myocardial dysfunction or myocardial stunning [10].…”

Relative Prognostic Value of Clinical Heart Failure and Early Echocardiographic Parameters in Acute Myocardial Infarction

“…Thus, in AMI it has been shown that discrepancies between subjective and objec tive measures of left ventricular function are not infrequent [5,[16][17][18], Therefore, it has been claimed that signs of clinical heart fail ure must be corroborated with objective measurements of left ventricular function to confirm a diagnosis of congestive heart fail ure [ 14], Gadsboll et al [ 19] found consider able interobserver variability in the evalua tion of clinical signs of heart failure in the 2nd week after AMI. Further confounding for the clinical evaluation is the fact that signs and symptoms of clinical heart failure may fluctuate over time and with treatment [20], Contrary, left ventricular systolic per formance appears to be an earlier and more stable marker of risk in the setting [5],…”

Acute pulmonary edema in patients with decompensated heart failure. Role of underlying cardiopathy on the prognosis

“…Although some studies have examined the relationship between survival and particular clinical signs of congestive heart failure (CHF) (in particular, the prognosis is poor for NYHA class IV patients), relatively few information is available as regards the survival of CHF patients who in the course of their illness have at some time been hospitalized with acute pulmonary edema (APE) [1][2][3][4][5]. In this study we investigated the clinical characteristics and survival of this group of patients and of subgroups defined by the etiology of their cardiopathy, and compared them with the characteristics and survival of CHF patients without APE.…”