Russian Heart Failure Journal 2007year Predicting development of heart failure in the first year after acute myocardial infarction


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2007/

Predicting development of heart failure in the first year after acute myocardial infarction

Bershtein L. L.

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Urgency. Despite the decreasing incidence of heart failure (HF) in acute myocardial infarction (AMI). HF preserves its role as a cause of hospitalizations and mortality in the remote period. Regularities of delayed HF after AMI are studied relatively scantily. Aim. Studying the prognostic value of some initial clinical, laboratory and instrumental parameters with respect to development of HF within 12 months after AMI. Materials and methods. 123 patients without previous HF who had had AMI with ST elevation and systemic thrombolysis and subsequently received drug therapy were evaluated. Clinical parameters were evaluated on presentation and at the study endpoint. ECG was recorded before and 3 hours after thrombolysis (ECG 1 and ECG 2). Number of leads with ST elevation (N STL), number of leads with abnormal Q (N QL), maximal ST elevation (maxSТ), and sum of ST elevations (sumSТ) were calculated. Maximal creatine kinase (CK) levels and CK MB fractions were evaluated from 5 assays performed before thrombolysis and then additionally 4 times with 6‑hour intervals. EchoCG was performed before thrombolysis, at discharge, and 12 months after AMI (echoCG 1, echoCG 2 and echoCG 12). In 12 months patients having completed the follow-up period formed groups HF0 (NYHA I FC) and HF1 (NYHA II–IV FC). Results. Group HF1 included 54 (44 %) patients mostly with NYHA II FC (43 patients, 80 %); group HF0 included 69 patients. The groups did not significantly differ by their drug therapy. Patients of group HF1 were significantly older, and their age exerted an independent effect on development of HF within 12 months (β=0.06 ± 0.03, р=0.02; OR =1.06 (95 % CI; 1,01–1,12)). Age >67.4 years predicted HF with sensitivity of 46 % and specificity of 90 %. Group HF1 contained more patients with frontal AMI; they had higher values of N STL, maxST and sumST, and more N QL on ECG-1 and ECG-2. Patients of Group HF1 had higher indices of local contractility (ILC) in echoCG-1 and echoCG-2, higher end-systolic index and mitral-septal separation in echoCG-2. Among parameters of echoCG-12, ILC best of all correlated with clinical signs of HF. Conclusion. Analyzing a number of available initial parameters allows prediction of HF within one year after AMI thereby revealing patients at high risk. Risk for HF increases in patients of older age. Among initial echoCG parameters, the most predictive one was ILC which correlated with clinical signs of HF better than other parameters of echoCG-12.

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