scholarly journals Predictors of the Use of Mineralocorticoid Receptor Antagonists in Patients With Left Ventricular Dysfunction Post‐ST‐Segment–Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Eric C. Wong ◽  
Christopher B. Fordyce ◽  
Graham Wong ◽  
Terry Lee ◽  
Michele Perry‐Arnesen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment

Background Guidelines recommend mineralocorticoid receptor antagonist (MRA) use in patients with left ventricular ejection fraction ≤40% following a myocardial infarction plus heart failure or diabetes mellitus, based on mortality benefit in the EPHESUS (Eplerenone Post‐Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial. The objective of this study was to evaluate the real‐world utilization of MRAs for patients with ST‐segment–elevation myocardial infarction (STEMI) with left ventricular dysfunction. Methods and Results The prospective, population‐based, Vancouver Coastal Health Authority STEMI database was linked with local outpatient cardiology records from 2007 to 2018. EPHESUS criteria were used to define post‐STEMI MRA eligibility (left ventricular ejection fraction ≤40% plus clinical heart failure or diabetes mellitus, and no dialysis‐dependent renal dysfunction). The primary outcome was MRA prescription among eligible patients at discharge and the secondary outcome was MRA prescription within 3 months postdischarge. Of 2691 patients with STEMI, 317 (12%) were MRA eligible, and 70 (22%) eligible patients were prescribed an MRA at discharge. Among eligible patients with no MRA at discharge, 12/126 (9.5%) with documented postdischarge follow‐up were prescribed an MRA within 3 months. In multivariable analysis, left ventricular ejection fraction (odds ratio [OR], 1.55 per 5% left ventricular ejection fraction decrease; 95% CI, 1.26–1.90) and calendar year (OR, 1.23 per year, 95% CI, 1.11–1.37) were associated with MRA prescription at discharge. Other prespecified variables were not associated with MRA prescription. Conclusions In this contemporary STEMI cohort, only 1 in 4 MRA‐eligible patients were prescribed an MRA within 3 months following hospitalization despite high‐quality evidence for use. Novel decision‐support tools are required to optimize pharmacotherapy decisions during hospitalization and follow‐up to target this gap in post‐STEMI care.

scholarly journals Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry

2020 ◽  
Vol 7 ◽  
Author(s):  
Jinying Zhou ◽  
Shiqin Yu ◽  
Yu Tan ◽  
Peng Zhou ◽  
Chen Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation

Objective: Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI.Methods: This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction < 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined.Results: In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI (r = 0.27, p = 0.01), age (r = 0.34, p < 0.01), and estimated glomerular filtration rate (r = −0.30, p < 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25−75th percentiles 1.5–3.3 μM vs. median 1.9 μM, 25−75th percentiles 1.5–2.7 μM; p = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all p > 0.05).Conclusions: TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03593928.

scholarly journals P1780 Left ventricular golbal longitudinal strain in acute myocardial infarction and incidence of in hospital heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Ebeid ◽  
R Abd El Hady ◽  
K El Khashab ◽  
M Husein
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background The occurrence of in-hospital heart failure in the acute phase of myocardial infarction carries an ominous prognosis and is often preceded by abrupt loss of functioning myocardium. However ,In hospital heart failure may occur in patients with apparently only minor myocardial injury and preserved or only moderately reduced left ventricular ejection fraction and still carries a significantly increased risk of adverse outcome. In patients with clinical symptoms of heart failure despite preserved left ventricular ejection fraction(heart failure with preserved ejection fraction), abnormalities in longitudinal myocardial mechanics have been reported suggesting that the discrepancy between near normal left ventricular ejection fraction and clinical symptoms may be partially explained by theses indices. Purpose Evaluation of the role of global longitudinal strain in prediction of the occurrence of in hospital heart failure in patients presenting with acute myocardial infarction particularly in patients with normal ,or moderately impaired ejection fraction. Methods forty patients with first attack of acute myocardial infarction were ranked according to killip class during their hospital admission and course. The patients were divided into two groups: Group 1: patients having in-hospital heart failure (killip class > 1).Group2: Patients not having in–hospital heart failure (killip class = 1). Echocardiogaraphic examination was done for them including global longitudinal strain within 72 hours after successful reperfusion .Comparison of different echocardiographic parameters between the two groups was done. Patients with mildly impaired ejection fraction (Ejection fraction > 40%) were studied for echocardiographic parameters correlated significantly with the occurrence of in-hospital heart failure . Results Patients with in-hospital heart failure had significantly impaired global longitudinal strain(-8.63%+1.57% vs -12.41%+1.31%, p = 0.000), lower left ventricular ejection fraction (34.17%+8.17% vs 42.92 %+7.98%,p < 0.001) and higher wall motion score index (1.57 + 0.32 vs 1.31 +0.24 ,p < 0.006). In patients with left ventricular ejection fraction >40% experienced in-hospital heart failure also exhibited significantly impaired global longitudinal strain p= 0.035 . Conclusion Global longitudinal strain can offer accurate, feasible, and non invasive predictor of hemodynamic deterioration in patients with myocardial infarction. Global longitudinal strain was superior to left ventricular ejection fraction , wall motion score index in evaluation of myocardial dysfunction specially in those with preserved left ventricular ejection fraction(EF > 40%).Global longitudinal strain was also superior to left ventricular ejection fraction , wall motion score index in detection of patients with Killip class II ( those without overt heart failure ,and who can be easily missed).

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