title: [Prognostic implications of left ventricular end-diastolic pressure in acute coronary syndromes with left ventricular ejection fraction of 40% or over].
abstract: BACKGROUND
  There is still debate concerning the impact of left ventricular end-diastolic pressure (LVEDP) on long-term prognosis after an acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  To assess LVEDP and its prognostic implications in ACS patients with left ventricular ejection fraction (LVEF) ≥40%.
  
  
  METHODS
  We performed a prospective, longitudinal study of 1329 ACS patients from a single center between 2004 and 2006. LVEDP was assessed at the beginning of the coronary angiogram. Patients with LVEF >40% were excluded (n=489). The population was divided into three groups: A - LVEDP ≤19 mmHg (n=186); B - LVEDP >19 and ≤27 mmHg (n=172); and C - LVEDP >27 mmHg (n=131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission.
  
  
  RESULTS
  Mean LVEDP was 22.8±7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p<0.01), higher peak levels of cardiac biomarkers, and lower LVEF (56.5±7.0 vs. 55.3±7.6 vs. 53.0±7.5%, p<0.01). There were no significant differences between the groups in terms of coronary anatomy, medical therapy during hospital stay and at discharge, or in-hospital mortality. With regard to the primary endpoint, cumulative freedom from congestive heart failure was higher in group A patients (99.4 vs. 97.6 vs. 94.4%, log rank p=0.02). In a multivariate Cox regression model, a 5-mmHg increase in LVEDP (HR 1.97, 95% CI 1.10-3.54, p=0.02) remained an independent predictor of the primary endpoint when adjusted for age, systolic function, atrial fibrillation, peak troponin I, renal function, and prescription of diuretics and beta-blockers.
  
  
  CONCLUSIONS
  In selected population LVEDP was a significant prognostic marker of future admission for congestive heart failure.
authors: Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal. rogeriopteixeira@gmail.com
authors: Rogério
authors: R
authors: Teixeira
authors: Carolina
authors: C
authors: Lourenço
authors: Rui
authors: R
authors: Baptista
authors: Elisabete
authors: E
authors: Jorge
authors: Paulo
authors: P
authors: Mendes
authors: Fátima
authors: F
authors: Saraiva
authors: Sílvia
authors: S
authors: Monteiro
authors: Francisco
authors: F
authors: Gonçalves
authors: Pedro
authors: P
authors: Monteiro
authors: Maria João
authors: MJ
authors: Ferreira
authors: Mário
authors: M
authors: Freitas
authors: Luís
authors: L
authors: Providência
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left; D017725:Ventricular Pressure