P881Differences during admission in patients with myocardial infarction with non-obstructive coronary arteries compared to myocardial infarction with obstructive lesions

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Alcon Duran ◽  
J Lopez Pais ◽  
D Galan Gil ◽  
B Izquierdo Coronel ◽  
M J Espinosa Pascual ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Coronary Arteries ◽  
Clinical Presentation ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Group Position ◽  
St Elevation

Abstract Introduction Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) means a non-negligible proportion of patients (pts) admitted for MI. However, there are still unsolved questions about this entity. The aim of our study is to analyse the differences between the MINOCA group compared with pts admitted for MI with obstructive coronary disease. Method Analytical and observational study developed in a Universitary Hospital, which covers 220.000 individuals. From january-2016 until december-2018 we reviewed all the pts that were admitted for MI who underwent coronariography. MINOCA pts (defined according 2016 ESC Working Group position paper) compared with MI pts with obstructive lesions. Results One hundred and nine from 521 pts admitted for MI in whom a coronariography was performed fulfilled the 2016 ESC criteria of MINOCA (20%). Clinical presentation showed no difference in Killip-Kimball classification (K-K > I was 6.1% in MI with obstructive lesions vs 6.5% in MINOCA pts, p 0.897). Chest pain (Angina) was more frequent in MI with obstructive lesions (82.8% vs 73.4%, p 0.027) and they also had more ST changes (ST elevation 41% vs 24%, p 0.001; ST descent 17% vs 8.3%, p 0.026). MINOCA pts had lower levels of troponine (troponine elevation less than 10 times the 99th percentile: 10.4% vs 26.6%, p<0.001). Left ventricular systolic dysfunction showed no difference neither in the % of pts with ejection fraction lower than 50% (MI with obstructive lesions: 32% vs MINOCA: 34.3%, p 0.659) nor in severe systolic dysfunction (ejection fraction lower than 30%: 4.9% in MI with obstructive lesions vs 7.4% in MINOCA pts, p 0.313). The average stay in MI pts with obstructive lesions was 12.6 days vs 8.9 days in MINOCA pts (p 0.274). Complications during hospital admission occurred in 17.6% of obstructive pts and in 13.8% of MINOCA pts (p 0.335). Only one MINOCA pts (0.9) died during admission compared to 3.4% of MI pts with obstructive lesions, being this result statistically non significant (p 0.213). Conclusions Although MINOCA pts have lower troponine levels and less severe alterations on the EKG, we did not find differences regarding left ventricular function and the rate of complications with hospital mortality that tended to be higher in patients with obstructive lesions.

scholarly journals Terminal QRS Distortion on Admission Electrocardiogram as a Predictor of Left Ventricular Systolic Dysfunction in Patients with ST Elevation Myocardial Infarction

2018 ◽  
Vol 11 (1) ◽  
pp. 42-49
Author(s):  
Mohammad Morshedul Ahsan ◽  
Md Abdul Kader Akanda ◽  
Sabina Hashem ◽  
Md Zillur Rahman ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Early Assessment ◽  
Acute Stemi ◽  
Group I ◽  
St Elevation

Background: Increased mortality rates due to coronary artery disease remains a big concern inthe field of cardiology. So early risk stratification is important in daily clinical practice. Risk assessment needs to be done shortly after admission, when only the history, physical examination and the ECG are available. The role of ECG in diagnosis and prognostication of acute myocardial infarction is well established. So this study was done to find out the association of terminal QRS distortion with left ventricular systolic dysfunction in patients with acute ST Elevation Myocardial Infarction.Methods: This prospective observational study was done in NICVD with acute STEMI patients who were eligible for thrombolysis, and was admitted in coronary care unit within 12 hours of onset of chest pain. After considering inclusion and exclusion criteria total 200 acute STEMI patients were taken purposively. 100 patients in group I with terminal QRS distortion and 100 patients in group II without terminal QRS distortion. Then Echocardiography was done to assess left ventricular systolic dysfunction.Results: In our study mean ejection fraction was significantly lower in group I (42.6 ± 5.4% vs 49.7 ± 5.3%, p=0.001).Mean ejection fraction was 40.4± 4.7% in terminal QRS distortion patients with anterior MI and 47.9± 5.9% in patients without terminal QRS distortion with anterior MI (p=0.001).Mean ejection fraction was 46.6± 6.4% in terminal QRS distortion patients with inferior MI and 53.9± 7.8% in patients without terminal QRS distortion patients with inferior MI (p=0.003).Out of the 7 variables location of MI and terminal QRS distortion were found to be the independent predictors for developing left ventricular systolic dysfunction with ORs being 5.20 and 3.21.respectively.Conclusion: ECG on admission in STEMI can predict short term prognosis and help in early assessment of severity of ischemia. Presence of terminal QRS distortion on admission ECG in STEMI is associated with LV systolic dysfunction. So it helps in early decision making for referral to a higher center by our grass root level doctors.Cardiovasc. j. 2018; 11(1): 42-49

Abstract P607: Interplay Between Post-Myocardial Infarction Left Ventricular Systolic Dysfunction and Atrial Fibrillation: Prognostic Implications for Post-Myocardial Infarction Acute Ischaemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ching Hui Sia ◽  
Benjamin YQ Tan ◽  
Huili Zheng ◽  
Andrew Ho ◽  
David Foo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Ventricular Systolic Dysfunction

Introduction: Acute myocardial infarction (MI) and acute ischaemic stroke (AIS) are leading causes of morbidity and mortality. There is scarce data examining the interplay between post-MI left ventricular systolic dysfunction (LVSD), with or without atrial fibrillation (AF), and subsequent AIS, especially in patients with milder degrees of LVSD (ejection fraction 40-49%). Evidence of an association would be helpful in developing new strategies of reducing AIS after MI. As such, we sought to study this relationship in a real-world population-based registry. Methods: This study involved linking national-level data from the Singapore Myocardial Infarction Registry with the Singapore Stroke Registry from 1st January 2007 to 31st December 2018. Both data sets have similar definitions for patient demographics. The ejection fraction (EF) and AF status were recorded during the MI episode. The outcome studied was the first instance of AIS that developed after the MI episode. We also studied the relationship between EF, AF and the severity of AIS as measured by the NIH Stroke Scale (NIHSS). Results: There were 64,512 patients available for analysis. The median age was 65.7 (IQR 56.1-76.5) and 69.5% were male. The median duration post-MI to develop AIS was 16.9 (IQR 1.6-46.1) months. There was an independent association between LVSD and the outcome of AIS (adjusted HR 1.18, 95% CI 1.10-1.27); this was evident even in mild forms of LVSD (adjusted HR 1.16, 95% CI 1.06-1.27). AF was not a statistically significant predictor of AIS in post-MI patients with LVSD. Amongst patients without AF, post-MI LVSD was associated with a more severe stroke and higher NIHSS. Conclusion: Post-MI LVSD is associated with the occurrence of subsequent AIS. Although this relationship was independent of AF status, patients with LVSD but no AF had suffered a more severe AIS. These findings support the need to develop effectives therapies to prevent AIS post-MI, especially among those with LVSD.

scholarly journals Diagnosis and Treatment of Asymptomatic Left Ventricular Systolic Dysfunction after Myocardial Infarction

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Laura Ajello ◽  
Giuseppe Coppola ◽  
Egle Corrado ◽  
Eluisa La Franca ◽  
Antonino Rotolo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Early Detection ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Diagnosis And Treatment ◽  
Ventricular Systolic Dysfunction

The increased survival after acute myocardial infarction induced an increase in heart failure with left ventricular systolic dysfunction. Early detection and treatment of asymptomatic left ventricular systolic dysfunction give the chance to improve outcomes and to reduce costs due to the management of patients with overt heart failure.

scholarly journals Systolic left ventricular dysfunction in patients with clinically suspected myocarditis

2020 ◽  
Vol 17 (4) ◽  
pp. 452-460
Author(s):  
N. P. Mitkovskaya ◽  
E. M. Balysh ◽  
T. V. Statkevich ◽  
N. A. Ladygina ◽  
E. B. Petrova ◽  
...  
Keyword(s):  
Heart Rate ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p <  0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2  = 4.3, p  < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3  % versus 22.2  %, respectively, χ2   =  6.4, p  < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r  =  0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.

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