Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Wohlfahrt, Peter; Jenča, Dominik; Melenovský, Vojtěch; Šramko, Marek; Kotrč, Martin; Želı́zko, Michael; Mrázková, Jolana; Adámková, Věra; Piťha, Jan; Kautzner, Josef

doi:10.3389/fcvm.2022.1051995

Cited by 7 publications

(2 citation statements)

References 47 publications

(40 reference statements)

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“…This study used data from the prospective Institute for Clinical and Experimental Medicine Acute Myocardial Infarction Registry (AMBITION). 16 The registry collects clinical data and biospecimens from consecutive patients hospitalized for acute coronary syndrome since June 2017 at the Institute for Clinical and Experimental Medicine, Prague, Czech Republic, a tertiary heart center with around‐the‐clock coronary intervention service. The Fourth Universal Definition of Myocardial Infarction has been used.…”

Section: Methodsmentioning

confidence: 99%

Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death

Wohlfahrt,

Jenča,

Melenovský

et al. 2024

JAHA

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Background Heart failure is a common complication after myocardial infarction (MI) and is associated with increased mortality. Whether remote heart failure symptoms assessment after MI can improve risk stratification is unknown. The authors evaluated the association of the 23‐item Kansas City Cardiomyopathy Questionnaire (KCCQ) with all‐cause mortality after MI. Methods and Results Prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart center between June 2017 and September 2022 were used. Patients remotely completed the KCCQ 1 month after discharge. A total of 1135 (aged 64±12 years, 26.7% women) of 1721 eligible patients completed the KCCQ. Ranges of KCCQ scores revealed that 30 (2.6%), 114 (10.0%), 274 (24.1%), and 717 (63.2%) had scores <25, 25 to 49, 50 to 74, and ≥75, respectively. During a mean follow‐up of 46 months (interquartile range, 29–61), 146 (12.9%) died. In a fully adjusted analysis, KCCQ scores <50 were independently associated with mortality (hazard ratio [HR], 6.05 for KCCQ <25, HR, 2.66 for KCCQ 25–49 versus KCCQ ≥50; both P <0.001). Adding the 30‐day KCCQ to clinical risk factors improved risk stratification: change in area under the curve of 2.6 (95% CI, 0.3–5.0), Brier score of −0.6 (95% CI, −1.0 to −0.2), and net reclassification improvement of 0.71 (95% CI, 0.45–1.04). KCCQ items most strongly associated with mortality were walking impairment, leg swelling, and change in symptoms. Conclusions Remote evaluation of heart failure symptoms using the KCCQ among patients recently discharged for MI identifies patients at risk for mortality. Whether closer follow‐up and targeted therapy can reduce mortality in high‐risk patients warrants further study.

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Section: Methodsmentioning

confidence: 99%

Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death

Wohlfahrt,

Jenča,

Melenovský

et al. 2024

JAHA

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“…This study used data from the prospective AMBITION (Institute for Clinical and Experimental Medicine Acute Myocardial Infarction Registry) registry, 7 which has been collecting clinical data and biospecimens from all consecutive patients hospitalized for acute coronary syndrome at a tertiary heart center since June 2017. The methods of this study were previously described.…”

Section: Methodsmentioning

confidence: 99%

Attenuation of Hypocretin/Orexin Signaling Is Associated With Increased Mortality After Myocardial Infarction

Wohlfahrt

Jenča

Melenovský

et al. 2023

JAHA

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Background The hypocretin/orexin system has been shown to play a role in heart failure. Whether it also influences myocardial infarction (MI) outcomes is unknown. We evaluated the effect of the rs7767652 minor allele T associated with decreased transcription of the hypocretin/orexin receptor‐2 and circulating orexin A concentrations on mortality risk after MI. Methods and Results Data from a single‐center, prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were analyzed. Patients without previous history of MI or heart failure were included. A random population sample was used to compare allele frequencies in the general population. Out of 1009 patients (aged 64±12 years, 74.6% men) after MI, 6.1% were homozygotes (TT) and 39.4% heterozygotes (CT) for minor allele. Allele frequencies in the MI group did not differ from 1953 subjects from general population (χ 2 P =0.62). At index hospitalization, MI size was the same, but ventricular fibrillation and the need for cardiopulmonary resuscitation were more prevalent in the TT allele variant. Among patients with ejection fraction ≤40% at discharge, the TT variant was associated with a lower increase in left ventricular ejection fraction during follow‐up ( P =0.03). During the 27‐month follow‐up, there was a statistically significant association of the TT variant with increased mortality risk (hazard ratio [HR], 2.83; P =0.001). Higher circulating orexin A was associated with a lower mortality risk (HR, 0.41; P <0.05). Conclusions Attenuation of hypocretin/orexin signaling is associated with increased mortality risk after MI. This effect may be partially explained by the increased arrhythmic risk and the effect on the left ventricular systolic function recovery.

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Prognostic impact of new‐onset atrial fibrillation in myocardial infarction with and without improved ejection fraction

Luo,

Qin,

Zhang

et al. 2024

ESC Heart Failure

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AimsImprovement in left ventricular ejection fraction (impEF) often presents in contemporary acute myocardial infarction (AMI) patients. New‐onset atrial fibrillation (NOAF) during AMI is an important predictor of subsequential heart failure (HF), while its impact on the trajectory of post‐MI left ventricular ejection fraction (LVEF) and prognostic implication in patients with and without impEF remains undetermined. We aimed to investigate the prognostic impacts of NOAF in AMI patients with and without impEF.Methods and resultsConsecutive AMI patients without a prior history of AF between February 2014 and March 2018 with baseline LVEF ≤ 40% and had ≥1 LVEF measurement after baseline were included. ImpEF was defined as a baseline LVEF ≤ 40% and a re‐evaluation showed both LVEF > 40% and an absolute increase of LVEF ≥ 10%. Persistently reduced EF (prEF) was defined as the second measurement of LVEF either ≤40% or an absolute increase of LVEF < 10%. The primary endpoint was a major adverse cardiac event (MACE) that was composed of cardiovascular death and HF hospitalization. Cox regression analysis and competing risk analysis were performed to assess the association of post‐MI NOAF with MACE. Among 293 patients (mean age: 66.6 ± 11.3 years, 79.2% of males), 145 (49.5%) had impEF and 67 (22.9%) developed NOAF. Higher heart rate (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.73–0.97; P = 0.015), prior MI (OR: 0.25, 95% CI: 0.09–0.69; P = 0.008), and STEMI (OR: 0.40, 95% CI: 0.21–0.77; P = 0.006) were independent predictors of post‐MI impEF. Within up to 5 years of follow‐up, there were 22 (15.2%) and 53 (35.8%) MACE in patients with impEF and prEF, respectively. NOAF was an independent predictor of MACE in patients with impEF (hazard ratio [HR]: 7.34, 95% CI: 2.49–21.59; P < 0.001) but not in those with prEF (HR: 0.78, 95% CI: 0.39–1.55; P = 0.483) after multivariable adjustment. Similar results were obtained when accounting for the competing risk of all‐cause death (subdistribution HR and 95% CIs in impEF and prEF were 6.47 [2.32–18.09] and 0.79 [0.39–1.61], respectively).ConclusionsThe NOAF was associated with an increased risk of cardiovascular outcomes in AMI patients with impEF.

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Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Cited by 7 publications

References 47 publications

Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death

Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death

Attenuation of Hypocretin/Orexin Signaling Is Associated With Increased Mortality After Myocardial Infarction

Prognostic impact of new‐onset atrial fibrillation in myocardial infarction with and without improved ejection fraction

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