The prognostic value of the left ventricular ejection fraction is dependent upon the severity of mitral regurgitation in patients with acute myocardial infarction

Korea Acute Myocardial Infarction Registry Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF≤40% (n=2,422 and 197, respectively) and LVEF>40% (n=12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥75 yr, Killip class ≥III, N-terminal pro-B-type natriuretic peptide>4,000 pg/mL, high-sensitivity C-reactive protein ≥2.59 mg/L, LVEF ≤40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF≤40% or EF>40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

Original languageEnglish
Pages (from-to)903-910
Number of pages8
JournalJournal of Korean Medical Science
Volume30
Issue number7
DOIs
Publication statusPublished - 2015

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Mitral Valve Insufficiency
Stroke Volume
Heart Ventricles
Myocardial Infarction
Percutaneous Coronary Intervention
Brain Natriuretic Peptide
Glomerular Filtration Rate
C-Reactive Protein
Registries
Echocardiography
Cause of Death
Multivariate Analysis
Mortality

Keywords

  • Acute myocardial infarction
  • Left ventricular ejection fraction
  • Mitral regurgitation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The prognostic value of the left ventricular ejection fraction is dependent upon the severity of mitral regurgitation in patients with acute myocardial infarction. / Korea Acute Myocardial Infarction Registry Investigators.

In: Journal of Korean Medical Science, Vol. 30, No. 7, 2015, p. 903-910.

Research output: Contribution to journalArticle

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abstract = "The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF≤40{\%} (n=2,422 and 197, respectively) and LVEF>40{\%} (n=12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥75 yr, Killip class ≥III, N-terminal pro-B-type natriuretic peptide>4,000 pg/mL, high-sensitivity C-reactive protein ≥2.59 mg/L, LVEF ≤40{\%}, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF≤40{\%} or EF>40{\%} were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.",
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author = "{Korea Acute Myocardial Infarction Registry Investigators} and Cho, {Jung Sun} and Youn, {Ho Joong} and Her, {Sung Ho} and Park, {Maen Won} and Kim, {Chan Joon} and Park, {Gyung Min} and Jeong, {Myung Ho} and Cho, {Jae Yeong} and Youngkeun Ahn and Kim, {Kye Hun} and Park, {Jong Chun} and Seung, {Ki Bae} and Cho, {Myeong Chan} and Kim, {Chong Jin} and Kim, {Young Jo} and Han, {Kyoo Rok} and Kim, {Hyo Soo} and Kim, {Jong Hyun} and Chae, {Shung Chull} and Hur, {Seung Ho} and Seong, {In Whan} and Hong, {Taek Jong} and Choi, {Dong Hoon} and Chae, {Jei Keon} and Rhew, {Jae Young} and Kim, {Doo Il} and Chae, {In Ho} and Junghan Yoon and Koo, {Bon Kwon} and Kim, {Byung Ok} and Lee, {Myoung Yong} and Kim, {Kee Sik} and Hwang, {Jin Yong} and Oh, {Seok Kyu} and Lee, {Nae Hee} and Jeong, {Kyoung Tae} and Tahk, {Seung Jea} and Bae, {Jang Ho} and Seung-Woon Rha and Park, {Keum Soo} and Ahn, {Tae Hoon} and Kim, {Moo Hyun} and Yang, {Joo Young} and Rhim, {Chong Yun} and Gwon, {Hyeon Cheol} and Park, {Seong Wook} and Koh, {Young Youp} and Joo, {Seung Jae} and Kim, {Soo Joong} and Jin, {Dong Kyu}",
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T1 - The prognostic value of the left ventricular ejection fraction is dependent upon the severity of mitral regurgitation in patients with acute myocardial infarction

AU - Korea Acute Myocardial Infarction Registry Investigators

AU - Cho, Jung Sun

AU - Youn, Ho Joong

AU - Her, Sung Ho

AU - Park, Maen Won

AU - Kim, Chan Joon

AU - Park, Gyung Min

AU - Jeong, Myung Ho

AU - Cho, Jae Yeong

AU - Ahn, Youngkeun

AU - Kim, Kye Hun

AU - Park, Jong Chun

AU - Seung, Ki Bae

AU - Cho, Myeong Chan

AU - Kim, Chong Jin

AU - Kim, Young Jo

AU - Han, Kyoo Rok

AU - Kim, Hyo Soo

AU - Kim, Jong Hyun

AU - Chae, Shung Chull

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Hong, Taek Jong

AU - Choi, Dong Hoon

AU - Chae, Jei Keon

AU - Rhew, Jae Young

AU - Kim, Doo Il

AU - Chae, In Ho

AU - Yoon, Junghan

AU - Koo, Bon Kwon

AU - Kim, Byung Ok

AU - Lee, Myoung Yong

AU - Kim, Kee Sik

AU - Hwang, Jin Yong

AU - Oh, Seok Kyu

AU - Lee, Nae Hee

AU - Jeong, Kyoung Tae

AU - Tahk, Seung Jea

AU - Bae, Jang Ho

AU - Rha, Seung-Woon

AU - Park, Keum Soo

AU - Ahn, Tae Hoon

AU - Kim, Moo Hyun

AU - Yang, Joo Young

AU - Rhim, Chong Yun

AU - Gwon, Hyeon Cheol

AU - Park, Seong Wook

AU - Koh, Young Youp

AU - Joo, Seung Jae

AU - Kim, Soo Joong

AU - Jin, Dong Kyu

PY - 2015

Y1 - 2015

N2 - The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF≤40% (n=2,422 and 197, respectively) and LVEF>40% (n=12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥75 yr, Killip class ≥III, N-terminal pro-B-type natriuretic peptide>4,000 pg/mL, high-sensitivity C-reactive protein ≥2.59 mg/L, LVEF ≤40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF≤40% or EF>40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

AB - The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF≤40% (n=2,422 and 197, respectively) and LVEF>40% (n=12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥75 yr, Killip class ≥III, N-terminal pro-B-type natriuretic peptide>4,000 pg/mL, high-sensitivity C-reactive protein ≥2.59 mg/L, LVEF ≤40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF≤40% or EF>40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

KW - Acute myocardial infarction

KW - Left ventricular ejection fraction

KW - Mitral regurgitation

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