Acute Heart Failure in Patients with Acute Myocardial Infarction with Preserved Ejection Fraction of Left Ventricle: Clinical-Hemodynamic, Electrophysiological Features and Influence on Prognosis

S.M. Коzhukhov, О.M. Parkhomenko, O.I. Irkin, Ya.M. Lutay, O.V. Shumakov, O.A. Skarzhevsky

Abstract


Acute heart failure (AHF) is a major public health burden worldwide. Of acute myocardial infarction (AMI) patients presenting with AHF, 30–55 % have a preserved ejection fraction (PEF). Our objective was to examine survival in this patient during long term follow-up.
Of 606 AMI patients with ST elevations on ECG and PEF (age 54.8 ± 0.4 years, 90.8 % male), 28.2 % had HFPEF (EF > 45 %) during first 24 hours. Patients with HFPEF had high rate of
VT/VF (p > 0.05), aneurism of left ventricle (p > 0.05). Also these patients had high level of glucose (p > 0.05) and C-reactive protein (p > 0.05). Patients with HFPEF had renal dysfunction: GRF was statistically significant lower on time of admission up to 10 day (both p > 0.05). Infarct size was smaller on 18.5 % compare to patients without AHF.
During hospital stay patients has similar end-diastolic, end-systolic volume and EF. Our data demonstrated that acute myocardial infarction patient with ejection fraction ≥ 45 % complicated sign and symptoms of acute heart failure has two time increase in cardiovascular death during five year (17.2 % compare to 9.3 % patients without AHF, p < 0.034).
Multiple clinical characteristics at the time of initial AMI with PEF presentation differed in participants with AHF vs. no AHF. While AHF was clearly associated with a lower GFR, high level of systemic inflammation, infarct size, etc. Long term prognosis in these patients characterizes decrease of rate of cardiovascular death during follow-up up to 5 years.


Keywords


acute myocardial infarction; congestive heart failure; clinical picture; hemodynamics; prognosis

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DOI: https://doi.org/10.22141/2224-0586.3.58.2014.83295

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