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Abstract
To determine the spectrum and prognostic implications of left and right ventricular
(LV and RV) ejection fractions (EFs) in acute myocardial infarction (AMI), radionuclide
ventriculography was performed in 114 consecutive patients, admitted without (Killip
class I, 78 patients) or with (Killip class II, 36 patients) clinical signs of pulmonary
congestion within 24 hours of onset of symptoms of a transmural AMI. Mean LVEF was
significantly lower in patients in Killip class II than in those in class I (0.32
± 0.11 vs 0.46 ± 0.15, p < 0.001) and in patients with anterior than inferior AMI
(0.34 ± 0.11 vs 0.52 ± 0.14, p < 0.001). Of the 36 patients with a severely depressed
(0.30 or less) LVEF, 15 (42%) were in Killip class I. Mean RVEF did not differ significantly
between Killip class I and II patients (0.42 ± 0.11 vs 0.40 ± 0.12, difference not
significant) but was significantly lower in patients with inferior than anterior AMI
(0.38 ± 0.09 vs 0.44 ± 0.11, p = 0.005). In patients with inferior AMI, a depressed
RVEF (0.38 or less) was associated with a normal LVEF in 30% and a depressed LVEF
in 20%, whereas in those with anterior AMI, a depressed RVEF, observed in 25% of patients,
occurred only in association with a depressed LVEF. At 1 year of follow-up, the 21
nonsurvivors differed significantly from the 93 survivors with respect to LVEF (0.35
± 0.11 vs 0.45 ± 0.14, p < 0.001), RVEF (0.35 ± 0.11 vs 0.43 ± 0.10, p = 0.006), proportion
in Killip class II (57 vs 28%, p = 0.02) and age (69 ± 13 vs 61 ± 11 years, p = 0.01).
Mortality rate was 47% in patients with an LVEF of 0.30 or less (group I) compared
with 5% in patients with an LVEF greater than 0.30 (group II, p < 0.001). In group
I patients, the mortality rate was 75% when RVEF was 0.38 or less, compared with 25%
when RVEF was more than 0.38 (p < 0.001). An RVEF of less or greater than 0.38 did
not influence mortality in group II patients. Multivariate analysis identified LVEF
of 0.30 or less, RVEF 0.38 or less and age as significant independent predictors of
mortality. These results show the wide variability in global ventricular function
among a subset of patients with AMI with clinical evidence of no or only mild LV failure.
They also show independent and additional adverse prognostic implications of a depressed
RVEF among a subset of patients with severely depressed LVEF (0.30 or less).
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Article Info
Publication History
Accepted:
April 25,
1986
Received in revised form:
April 24,
1986
Received:
February 19,
1986
Footnotes
☆This study was supported in part by SCOR for Ischemic Heart Disease Grant HL-17651 from the National Institutes of Health, Bethesda, Maryland.
Identification
Copyright
© 1986 Published by Elsevier Inc.
