Predicting Persistent Left Ventricular Dysfunction Following Myocardial Infarction: The PREDICTS Study

Abstract

Background: Persistent severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) is associated with increased mortality and is a class I indication for implantation of a cardioverter-defibrillator.

Objectives: This study developed models and assessed independent predictors of LV recovery to >35% and ≥50% after 90-day follow-up in patients presenting with acute MI and severe LV dysfunction.

Methods: Our multicenter prospective observational study enrolled participants with ejection fraction (EF) of ≤35% at the time of MI (n = 231). Predictors for EF recovery to >35% and ≥50% were identified after multivariate modeling and validated in a separate cohort (n = 236).

Results: In the PREDICTS (PREDiction of ICd Treatment Study) study, 43% of patients had persistent EF ≤35%, 31% had an EF of 36% to 49%, and 26% had an EF ≥50%. The model that best predicted recovery of EF to >35% included EF at presentation, length of stay, prior MI, lateral wall motion abnormality at presentation, and peak troponin. The model that best predicted recovery of EF to ≥50% included EF at presentation, peak troponin, prior MI, and presentation with ventricular fibrillation or cardiac arrest. After predictors were transformed into point scores, the lowest point scores predicted a 9% and 4% probability of EF recovery to >35% and ≥50%, respectively, whereas profiles with the highest point scores predicted an 87% and 49% probability of EF recovery to >35% and ≥50%, respectively.

Conclusions: In patients with severe systolic dysfunction following acute MI with an EF ≤35%, 57% had EF recovery to >35%. A model using clinical variables present at the time of MI can help predict EF recovery.

Keywords: heart failure; remodeling; risk assessment; ventricular ejection fraction.

Figure 1. Frequency of EF Recovery ≥35%

The observed left ventricular functional recovery to an ejection fraction (EF) >35% 90 days after the index myocardial infarction improved as point score increased (n = number of participants in the derivation set).

Figure 2. Frequency of EF Recovery ≥50%

The observed left ventricular functional recovery to an EF ≥50% 90 days after the index myocardial infarction also improved as point score rose (n = number of participants in the derivation set). Abbreviations as in Figure 1.

Central Illustration. Left Ventricular Dysfunction after Acute MI: Ejection Fraction 90 Days Acute Myocardial with Severe Systolic Dysfunction (EF ≤35%)

Severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) is associated with increased mortality. To better determine which patients with an ejection fraction (EF) ≤35% at time of acute MI may be more likely to improve systolic function, models assessing variables that predict LV recovery to an EF >35% and ≥50% 90 days after the event were developed. Although more patients continue to experience severe dysfunction, several variables predict partial or near normal recovery in these patients. VF = ventricular fibrillation.