title: Heart failure with preserved left ventricular ejection fraction in patients with acute myocardial infarction.
abstract: BACKGROUND
  The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated.
  
  
  OBJECTIVE
  To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality.
  
  
  METHODS
  Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models.
  
  
  RESULTS
  Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35-6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality.
  
  
  CONCLUSIONS
  One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Lucas
authors.initials: L
authors.lastname: Antonelli
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Marcia Regina Pinho
authors.initials: MR
authors.lastname: Makdisse
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Alessandra Graça
authors.initials: AG
authors.lastname: Correa
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Carolina
authors.initials: C
authors.lastname: Pereira
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Franken
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Anderson Nunes
authors.initials: AN
authors.lastname: Fava
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Carlos Vicente
authors.initials: CV
authors.lastname: Serrano Junior
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, BR.
authors.forename: Antonio Eduardo Pereira
authors.initials: AE
authors.lastname: Pesaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003971:Diastole / Q000502:physiology; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology*; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology