Heart Failure After Acute Coronary Syndrome: A Comprehensive Analysis from Bosnia and Herzegovina

Abstract

Background: The incidence of HF following ACS remains unacceptably high at discharge and several identified risk factors contribute to the development of HF in this context.

Objective: This study investigated the prevalence and clinical significance of HF in patients admitted to the Clinic for Heart, Blood Vessels, and Rheumatic Diseases at the Clinical Center of the University of Sarajevo following ACS.

Methods: This retrospective observational study was conducted at the Clinic for Heart, Blood Vessels, and Rheumatic Diseases of the Clinical Center of the University of Sarajevo between February 1^st and April 1^st, 2023, involving patients who were admitted because of ACS.

Results: Patients with HFrEF were significantly (p=0.034) older (70.0 (62.0;76.0) vs 67.0 (57.5;75.0)), had (p=0.046) higher median score of LDH (321.5 (222.3; 501.5) vs. 256.0 (200.0; 420.0)), fibrinogen (p=0.047) (4.5 (3.2; 5.1) vs 3.6 (2.8; 5.0)), and NT-proBNP (p<0.001) (3705.0 (2500.0; 12559.5) vs. 500.0 (275.0; 333.0)), had enlarged left atrium diameter (3.9 (3.4; 4.4) vs 3.6 (3.1; 4.1)), enlarged left ventricular diameter both in diastole (5.1 (4.5; 5.8) vs 4.6 (4.1; 5.1)) and systole (3.7 (3.2; 4.1) vs 3.5 (3.1; 3.7)), thinner interventricular septum diameter both in diastole (1.1 (1.0; 1.2) vs 1.2 (1.1; 1.3)) and systole (1.3 (1.2; 1.5) vs. 1.4 (1.3; 1.5)) and elevated right ventricular systolic pressure (37.0 (30.0; 47.5) vs. 35.0 (28.0; 40.0 )) compared to patients without HFrEF. Severe mitral regurgitation was more observed in group of patients with HFrEF (p<0.001).

Conclusion: HFrEF patients showed a 40% incidence of post-ACS, had elevated LDH, fibrinogen, and NT-proBNP levels, along with distinct echocardiographic differences, including enlarged heart chambers and higher mitral regurgitation rates following ACS. Early HF risk factor management is crucial for optimizing outcomes in ACS patients.

Keywords: ACS; HFrEF; echocardiography; heart diseases; ventriculat function.