Approximately one-third of young patients were found to have left ventricular systolic dysfunction after acute myocardial infarction (MI), of whom > 40% had ejection fraction (EF) recovery, according to a study published in the Journal of the American College of Cardiology.
Left ventricular EF is a common tool used to identify patients who are at risk for adverse CV events and increased mortality after an acute MI. The frequency of EF recovery and the association with this event with long-term outcomes in patients who experience MI at a young age is not clear.
In this retrospective cohort study, the data of patients who experienced their first MI before age 50 years and were treated at 2 academic medical centers in Boston between 2000 and 2016, were examined. Only patients who experienced a type 1 MI on index admission were included. Patients with coronary artery disease were excluded. Baseline EF and follow-up EF (within 180 days post-MI) were determined for each individual through comprehensive review of all available medical records. All-cause and CV death were the study’s primary outcomes of interest.
Of the 1724 participants who had EF measured at the time of their index MI, 503 (29%) had an abnormal EF (ie, EF <50%; mean EF, 39%), and 1221 (71%) had normal EF (mean, EF 60%). Patients with abnormal vs normal baseline EF were more likely to be white, and to have experienced ST-segment elevation MI, diabetes, greater troponin values, and greater severity of angiographic coronary artery disease. Of the 216 patients with an abnormal baseline EF and available follow-up data, 42% experienced absolute EF recovery (≥50%). There were no significant differences in sex, age, or most major CV risk factors between patients with and without EF recovery. Patients who had vs did not have EF recovery were more likely to use alcohol, had more severe angiographic coronary artery disease, and a higher burden of comorbidities. Over a median follow-up of 11.1 years (interquartile range, 7.1-14.1), EF was found to be associated with an approximate 8- (adjusted hazard ratio, 0.12; P= .001) and 10-fold (adjusted hazard ratio: 0.10; P= 0.025) reduction in all-cause and cardiovascular mortality, respectively.
Study limitations include its retrospective design, and inherent limitations associated with the assessment of EF using echocardiography.
“Our findings suggest the need to reassess EF among young patients with a baseline EF <50%, especially given the implications on long-term prognosis and management,” noted the study authors.
Wu WY, Biery DW, Singh A, Divakaran S, Berman AN, Ayuba G, et al. Recovery of left ventricular systolic function and clinical outcomes in young adults with myocardial infarction. J Am Coll Cardiol. 2020 Jun 9;75(22):2804-2815.