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Lim, Rhee, Jeong, Choi, Shin, Kim, Kim, Moon, Hong, Ahn, Cho, Park, and Kang: Predictive Factors for the Recovery of Left Ventricular Dysfunction in Patients with Acute Myocardial Infarction
Original Article
Korean Circulation Journal

Korean Circulation Journal 2007; 37(3): 113-118.

Published online: 31 March 2007

DOI: https://doi.org/10.4070/kcj.2007.37.3.113

Predictive Factors for the Recovery of Left Ventricular Dysfunction in Patients with Acute Myocardial Infarction

Sang Chun Lim, RN, Jung Ae Rhee, MD, Myung Ho Jeong, MD, Jin Soo Choi, MD, Eun Suk Shin, RN, Kye Hun Kim, MD, Ju Han Kim, MD, Jae Youn Moon, MD, Young Joon Hong, MD, Young Keun Ahn, MD, Jeong Gwang Cho, MD, Jong Chun Park, MD, Jung Chaee Kang, MD

The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.

Corresponding author (myungho@chollian.net)

Received 23 October 2006       Revised 7 February 2007       Accepted 28 February 2006

© 2007, The Korean Society of Circulation

Abstract

Background and Objectives

The left ventricular ejection fraction (LVEF) is known to be a significant prognostic factor for patients with acute myocardial infarction (AMI). The aim of this study was to investigate clinical or therapeutic factors associated with the recovery of a low LVEF for patients with AMI.

Subjects and Methods

From January to December 2004, we enrolled 89 patients (mean age: 62.5±10.6 years, 43 males and 26 females) with AMI and who had a LVEF less than 50%. Forty five patients whose LVEF improved more than 10% were classified as group I (mean age: 62.4±10.4 years, 34 males and 11 females) and 44 patients whose LVEF was not changed or decreased were classified as group II (mean age: 62.3±10.9 years, 29 males and 15 females). The clinical variables, including risk factors and the pain-to-door time, the biochemical markers of myocardial injury, the coronary angiographic findings and the treatment-related variables, were compared between the two groups.

Results

The cardiovascular risk factors were not different between the groups. The location of infarction, the success rate of percutaneous coronary intervention and the coronary angiographic lesion morphologies were not different between the groups. However, the pain-to-door time was significantly shorter in group I than in group II (6.0±9.5 vs 22.4±7.5 hours, respectively, p=0.046). Improved control of risk factors was not associated with the recovery of LV function. The use of beta-blocker, statin, anti-platelet agents, vasodilators and diuretics were not different between the groups. However, the use of angiotensin converting enzyme inhibitor (ACEI) was more common in group I than group II (79.3% vs 47.4%, respectively, p=0.03).

Conclusion

A shorter pain-to-door time and the use of ACEI were significant predictors of the recovery of LV dysfunction for patients with AMI.

Keywords: Myocardial infarction, Heart failure, congestive, Angiotensin

Figures and Tables

Table 1
Baseline clinical characteristics
kcj-37-113-i001

ASTEMI: acute ST elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft, LVEF: left ventricular ejection fraction

Table 2
Comparison of biochemical markers of cardiac myocardial injury
kcj-37-113-i002

CK: creatinine kinase, CK-MB: MB fraction of creatinine kinase, cTnT: cardiac specific troponin C, cTnI: cardiac specific troponin I, CRP: C-reactive protein

Table 3
Comparison of coronary angiographic characteristics
kcj-37-113-i003

LAD: left anterior descending coronary artery, RCA: right coronary artery, LCx: left circumflex coronary artery, TIMI: thrombolysis in myocardial infarction, ACC/AHA: American College of Cardiology/American Heart Association

Table 4
Comparison of the prescribed medications
kcj-37-113-i004

ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin II receptor blocker, CCB: calcium channel blocker

Table 5
Changes of echocardiographic parameters
kcj-37-113-i005

LVEDD: left ventricular end diastolic dimension, LVESD: left ventricular end systolic dimension, LVEDV: left ventricular end diastolic volume, LVESV: left ventricular end systolic volume, LVEF: left ventricular ejection fraction, TWMS: total wall motion score

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