MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure.

Autores de INCLIVA

• 

  Victor Marcos Garcés

  Autor

• 

  Héctor Manuel Merenciano González

  Autor

• Ana Gabaldón Pérez

  Autor

• 

  Julio Nuñez Villota

  Autor

• Nerea Júlia Pérez Solé

  Autor

• César Rios Navarro

  Autor

• Elena Victoria De Dios Lluch

  Autor

• 

  Francisco Javier Chorro Gascó

  Autor

• 

  Vicent Bodí Peris

  Autor

Participantes ajenos a INCLIVA

• Gavara, Jose
• Lopez-Lereu, Maria P
• Monmeneu, Jose V
• Valente, Filipa
• Lorenzatti, Daniel
• Domenech-Ximenos, Blanca
• Alonso Tello, Albert
• Maymi-Ballesteros, Manel
• Rello-Sabate, Pau
• Morr, Carlos Igor
• Ortiz-Perez, Jose T
• Rodriguez-Palomares, Jose F

Grupos y Plataformas de I+D+i

• Grupo de Investigación en Electrofisiología cardiaca experimental

  

  Leading Researcher

  Antonio M. Alberola Aguilar

• Grupo de Investigación en Insuficiencia Cardiaca

  

  Established Researcher

  Julio Nuñez Villota

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF).; PURPOSE: To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70years) and nonelderly patients after STEMI.; STUDY TYPE: Prospective.; POPULATION: Multicenter registry of 759 reperfused STEMI patients (23.3% elderly).; FIELD STRENGTH/SEQUENCE: 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences.; ASSESSMENT: One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, =50%), mildly reduced (mr-LVEF, 41%-49%), or reduced (r-LVEF, =40%). Median follow-up was 5 [2.33-7.54] years.; STATISTICAL TESTS: Univariable (Student's t, Mann-Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P<0.05 was considered statistically significant.; RESULTS: Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91-0.98]) and elderly patients (HR 0.94 [0.91-0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67-22.32]) and elderly patients (HR 7.55 [3.29-17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54-8.68]). Less transitions to higher LVEF states (n=19, 30.2% vs. n=98, 53%) and more transitions to AHF state (n=34, 53.9% vs. n=45, 24.3%) were observed in elderly than nonelderly patients.; DATA CONCLUSION: MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group.; EVIDENCE LEVEL: 2.; TECHNICAL EFFICACY: Stage 2. © 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine

Keywords

• acute myocardial infarction; elderly; left ventricular ejection fraction; acute heart failure