AUTHOR=Wohlfahrt Peter , Jenča Dominik , Melenovský Vojtěch , Šramko Marek , Kotrč Martin , Želízko Michael , Mrázková Jolana , Adámková Věra , Pitha Jan , Kautzner Josef 

TITLE=Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1051995

DOI=10.3389/fcvm.2022.1051995

ISSN=2297-055X

ABSTRACT=Background Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology and trajectories of EF after MI.
Methods Data from a single-centre prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology centre were utilized.
Results Out of 1593 patients in the registry, 1065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF<40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF >50% in 501 (47.0%). Patients with EF<40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and more often had HF signs requiring intravenous diuretic. Among subjects with EF<40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF>50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF>40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. 
Conclusions In the current era, 22% of patients after the first MI have EF below 40%. Out of them, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.