Left ventricular dysfunction after acute myocardial infarction--the impact of cardiovascular risk factors.
BACKGROUND
Left ventricular (LV) systolic function is an important prognostic factor in coronary heart disease. Left ventricular ejection fraction (LVEF) should be assessed in all patients after acute myocardial infarction (AMI). Although reperfusion therapy has been found effective in the reduction of complications of AMI, LVEF impairment is a common consequence of an acute coronary event. The aim of this study was to estimate the incidence of LVEF depression after ST-elevation myocardial infarction (STEMI) and to evaluate the effect of previous cardiovascular risk factors on the risk of LV dysfunction.


METHODS
One hundred and forty-seven consecutive patients with a first STEMI were included in this study. Most patients were male (70.7%) and mean age was 60.7 years. LVEF was assessed by echocardiography (using the single-plane area-length method and automatic border detection). LV systolic function was considered depressed when ejection fraction was less than 45 %. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was fitted to assess the independent effect of each variable.


RESULTS
Incidence of LV dysfunction was 55.8% in STEMI patients. No association was found between gender or age and LVEF impairment. The proportion of patients with diabetes was higher in the impaired LVEF group than in normal LVEF patients (44.7% vs. 31.7%, p = 0.12); the prevalence of smoking was also higher in patients with LV dysfunction (46.9% vs. 33.8%, p = 0.11). On the other hand, dyslipidemia was less common in patients with depressed LV function (35.4% vs. 56.9%, p = 0.01). Hypertension was not associated with impaired LVEF. After adjustment for ST-elevation location and number of vessels with critical stenosis, diabetes and smoking were associated with a significantly higher risk of LVEF impairment (diabetes: OR = 3.73, 95% CI 1.25-11.16; smoking: OR = 3.9, 95% CI 1.37-11.07) and dyslipidemia with a significantly lower risk of LV dysfunction (OR: 0.37, 95% CI 0.15-0.88).


CONCLUSIONS
In STEMI patients, previous cardiovascular risk factors have a significant impact on the likelihood of LV dysfunction and hence could influence long-term prognosis.
Mateus
Pedro S
PS
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
Dias
Carla Costa
CC
Betrencourt
Nuno
N
Adão
Luís
L
Santos
Lino
L
Sampaio
Francisco
F
Mateus
Carlos
C
Primo
João
J
Simões
Lino
L
Barros
Henrique
H
Ribeiro
Vasco Gama
VG
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology*