title: Interrelation of left ventricular ejection fraction, pulmonary congestion and outcome in acute myocardial infarction.
abstract: The interrelation of different grades of pulmonary congestion evaluated by chest roentgenogram in the coronary care unit, predischarge left ventricular (LV) ejection fraction (EF) and long-term prognosis was studied in 1,850 surviving patients of acute myocardial infarction (AMI). Pulmonary congestion was categorized as: none, mild or moderate, or severe; LVEF was classified as: greater than or equal to 40%, 25 to 39%, or less than 25%. The majority of patients (1,060; 57%) had an LVEF greater than or equal to 40% and no signs of pulmonary congestion. Severe pulmonary congestion was noted in 63 patients (3.4%), 17 with LVEF less than 25% and 16 with LVEF greater than or equal to 40%. One hundred twenty-five patients (6.8%) had an LVEF less than 25%, 49 of whom had no signs of pulmonary congestion. During a mean 2-year follow-up, cardiac mortality occurred in 212 patients (11.5%). The cardiac mortality rate was related to both predischarge LVEF impairment and severity of pulmonary congestion. Cardiac mortality hazard ratios (95% confidence intervals [CI]) for LVEF less than 25%, and 25 to 39% were 5.32 (CI 3.49, 8.13; p less than 0.0001) and 2.91 (CI 2.10, 4.02; p less than 0.0001), respectively, where a referent hazard ratio of 1 was assigned to patients with LVEF greater than or equal to 40% and to those with no pulmonary congestion. Development of pulmonary congestion during AMI significantly increased the cardiac mortality risk derived from LVEF, with a marked mortality effect in patients with severe pulmonary congestion; (hazard ratio 4.20; 95% CI 2.67, 6.62; p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Heart Research Follow-Up Program, University of Rochester School of Medicine and Dentistry, New York.
authors.forename: S
authors.initials: S
authors.lastname: Gottlieb
authors.forename: A J
authors.initials: AJ
authors.lastname: Moss
authors.forename: M
authors.initials: M
authors.lastname: McDermott
authors.forename: S
authors.initials: S
authors.lastname: Eberly
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D015635:Radionuclide Ventriculography; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D016277:Ventricular Function, Left / Q000502:physiology*