title: Determinants of left ventricular systolic function recovery after an acute coronary syndrome.
abstract: BACKGROUND
  Ischemic heart disease is a major cause of heart failure in western societies. However, the factors that may influence left ventricular function (LVF) recovery after an acute coronary syndrome (ACS) are still unclear.
  
  
  OBJECTIVE
  To identify variables that may influence LVF evolution one year after ACS.
  
  
  METHODS
  104 patients hospitalized with ACS between 7/1/2001 and 12/31/2002 and with systolic dysfunction--defined as an echocardiographic ejection fraction (EF) < or = 45%--were randomly allocated to a planned coronary follow-up program (FUP) or a general cardiology clinic (GC); patients from both groups were also randomly referred to a structured cardiac rehabilitation program (CRP). EF was re-assessed at one year. We compared differences between patients who recovered left ventricular function (EF > 45%; group 1) and those who did not (group 2).
  
  
  RESULTS
  One year after discharge, 44.2% of the patients had recovered function. There were no significant differences between the groups in gender (77.7 vs. 76.5% male), age (56 vs. 59 years), hypertension, diabetes, dyslipidemia, smoking habits or family history. A previous history of cardiovascular events was more frequent in group 2 (11.1% vs. 35.3%, p = 0.03). Cardiac catheterization was performed before discharge in 88.8% and 88.2% in groups 1 and 2 respectively (p = NS); no differences were found in coronary anatomy between the two groups. Angioplasty was performed in 54.2% in group 1 and 50% in group 2 (p = NS). There were no differences in the use of angiotensin-converting enzyme inhibitors (83.3% vs. 87.5%), beta-blockers (87.5% vs. 87.5%), nitrates (37.5% vs. 33.3%), aspirin (95.8% vs. 95.8%), statins (79.1% vs. 75%) or diuretics (20.8% vs. 45.8%). There was no significant difference in LVF recovery between patients randomized to FUP or GC (38.5% vs. 54.5%). 87.5% of patients who completed the CRP had normal EF at one year compared to 32.7% of patients not referred to the program (p = 0.009). Although EF improved in both groups, this improvement was greater in patients who completed a CRP (EF 8% vs. 5%, p = 0.003).
  
  
  CONCLUSIONS
  A previous cardiovascular event and completion of a CRP were the only variables that influenced LVF recovery. Thus, enrollment in a CRP, in addition to standard therapy, could be an important therapeutic measure in patients with systolic dysfunction after ACS; our data suggest that these programs should be more widely used.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. almeidasampaio@clix.pt
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.forename: Pedro
authors.initials: P
authors.lastname: Mateus
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: Carla Costa
authors.initials: CC
authors.lastname: Dias
authors.forename: Luís
authors.initials: L
authors.lastname: Adão
authors.forename: Lino
authors.initials: L
authors.lastname: Santos
authors.forename: Madalena
authors.initials: M
authors.lastname: Teixeira
authors.forename: Lino
authors.initials: L
authors.lastname: Simões
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation* / Q000628:therapy; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left