Trygve S Hall1, Thomas G von Lueder2, Faiez Zannad3, Patrick Rossignol3, Kevin Duarte3, Tahar Chouihed4, Kenneth Dickstein5, Dan Atar6, Stefan Agewall6, Nicolas Girerd3. 1. Department of Cardiology B, Oslo University Hospital, Oslo, Norway. Electronic address: tshall@online.no. 2. Department of Cardiology B, Oslo University Hospital, Oslo, Norway. 3. INSERM, Centre d'Investigation Clinique - 1433 and Unité 1116, Nancy, France; CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France. 4. INSERM, Centre d'Investigation Clinique - 1433 and Unité 1116, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France; Emergency Department, CHU Nancy, Nancy, France. 5. Division of Cardiology, Stavanger University Hospital, Stavanger, Norway. 6. Department of Cardiology B, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
BACKGROUND: Identifying risk factors for specific modes of death in patients with heart failure (HF) or left ventricular (LV) dysfunction after acute myocardial infarction (MI) may help to avert events. We sought to evaluate LV ejection fraction (LVEF) as a prognosticator of specific death modes. METHODS AND RESULTS: In an individual patient data meta-analysis of four merged trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT), Cox modelling was performed to study the association between baseline LVEF from 19,740 patients and types of death during follow-up. Over a median follow-up of 707 days 3419 deaths occurred. The distribution pattern for mode of death was similar across categories (LVEF < 25%, LVEF 25-35%, and LVEF > 35%). In multivariable models, the risk of all types of death increased with decreasing LVEF. If compared to LVEF > 35%, LVEF < 25% was associated with a 113% increased risk of sudden death (hazard ratio (HR) 2.13, 95% confidence interval (CI) 1.53-2.98), a 170% increased risk of HF death (HR 2.70, 95% CI 1.83-3.98), a 66% increased risk of other cardiovascular (CV) death (HR 1.66, 95% CI 1.14-2.42), and a 90% increased risk of non CV death (HR 1.90, 95% CI 1.15-3.14). CONCLUSION: In patients with HF or LV dysfunction after acute MI, low LVEF is a ubiquitous risk marker associated with death regardless of type. The different modes of death are fairly equally represented throughout the categories of LVEF and sudden death remains a significant mode of death also in patients with LVEF > 35%.
RCT Entities:
BACKGROUND: Identifying risk factors for specific modes of death in patients with heart failure (HF) or left ventricular (LV) dysfunction after acute myocardial infarction (MI) may help to avert events. We sought to evaluate LV ejection fraction (LVEF) as a prognosticator of specific death modes. METHODS AND RESULTS: In an individual patient data meta-analysis of four merged trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT), Cox modelling was performed to study the association between baseline LVEF from 19,740 patients and types of death during follow-up. Over a median follow-up of 707 days 3419 deaths occurred. The distribution pattern for mode of death was similar across categories (LVEF < 25%, LVEF 25-35%, and LVEF > 35%). In multivariable models, the risk of all types of death increased with decreasing LVEF. If compared to LVEF > 35%, LVEF < 25% was associated with a 113% increased risk of sudden death (hazard ratio (HR) 2.13, 95% confidence interval (CI) 1.53-2.98), a 170% increased risk of HF death (HR 2.70, 95% CI 1.83-3.98), a 66% increased risk of other cardiovascular (CV) death (HR 1.66, 95% CI 1.14-2.42), and a 90% increased risk of non CV death (HR 1.90, 95% CI 1.15-3.14). CONCLUSION: In patients with HF or LV dysfunction after acute MI, low LVEF is a ubiquitous risk marker associated with death regardless of type. The different modes of death are fairly equally represented throughout the categories of LVEF and sudden death remains a significant mode of death also in patients with LVEF > 35%.
Authors: Fatima J El-Hamad; Safa Y Bonabi; Alexander Müller; Alexander Steger; Georg Schmidt; Mathias Baumert Journal: Front Physiol Date: 2020-11-09 Impact factor: 4.566
Authors: Seok Oh; Ju Han Kim; Kyung Hoon Cho; Min Chul Kim; Doo Sun Sim; Young Joon Hong; Youngkeun Ahn; Myung Ho Jeong Journal: Front Cardiovasc Med Date: 2022-07-22