In-Hospital Measurement of Left Ventricular Ejection Fraction and One-Year Outcomes in Acute Coronary Syndromes: Results from the IMMEDIATE Trial.
coronary syndromes (ACS) remain a leading cause of morbidity and mortality in the United
States. Reduced left ventricular ejection fraction (LVEF) is a known marker for
increased mortality, and 30-day LVEF determined by clinical study core centers following
ACS is an established indicator of poor clinical outcome. However, the relationship
between LVEF measured during hospital... read moreization for ACS and the occurrence within one year
of death or heart failure (HF) are less well-defined. We hypothesized that reduced
in-hospital LVEF was a marker of increased risk of death or HF hospitalization at one
year. As a secondary goal, we tested whether in-hospital LVEF was higher among IMMEDIATE
Trial participants randomized to GIK as compared to those randomized to placebo. We did
a retrospective analysis of participants in the IMMEDIATE (Immediate Myocardial
Metabolic Enhancement During Initial Assessment and Treatment in Emergency care) Trial
who had LVEF measured by cardiac catheterization or echocardiogram during
hospitalization (N = 445).Adjusting for age and history of coronary artery disease
(CAD), lower LVEF was significantly associated with one-year mortality or
hospitalization for HF. For every 5% LVEF reduction, the hazard ratio [HR] was 1.26 (95%
CI 1.15, 1.38, P < 0.001); participants with LVEF < 40% had higher hazard of
one-year mortality or hospitalization for HF than those with LVEF > 40 (HR 3.59; 95%
CI 2.05, 6.27, P < 0.001). The HRs for the association of LVEF with the study
outcomes were similar whether measured by cardiac catheterization or by
echocardiography, (respectively, HR 1.32; 95% CI 1.15, 1.51 and 1.21; 95% CI 1.106,
1.35, interaction P = 0.32) and whether done within 24 hours or not within 24 hours
(respectively, HR 1.28; 95% CI 1.10, 1.50 and 1.23; 95% CI 1.10, 1.38, interaction P =
0.67). Lower in-hospital LVEF was associated with higher rates of one-year mortality and
hospitalization for HF in patients hospitalized with ACS, regardless of the method of
LVEF assessment, or the timing during hospitalization. This has prognostic implications
for clinical practice and suggests the possibility of using various methods of LVEF
determination in clinical research.
Thesis (M.S.)--Tufts University, 2014.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Harry Selker.
Committee: Robin Ruthazer, Joni Beshansky, and Gordon Huggins.
Keyword: Health sciences.read less