Prognostic value of symptoms and signs of advanced heart failure and low left ventricle ejection fraction in patients after myocardial infarction with chronic heart failure

INTRODUCTION: Prognosis in patients (pts) after myocardial infarction (MI) with chronic heart failure (CHF) and asymptomatic left ventricular dysfunction (ALVD) differs. Acute coronary syndromes (ACS) worsen CHF and prognosis in these pts. A diagnostic tool that identifies the group of high risk pts is needed. Prognostic factors include left ventricle ejection fraction (LVEF) and stage of heart failure. The aim of the study was evaluation if decreased LVEF worsen prognosis in pts with CHF and ALVD and whether LVEF is more powerful predictor of poor prognosis than severity of heart failure. MATERIAL AND METHODS: 112 consecutive pts (95 men and 17 women age range 34-75, mean 52.9) post MI in stage B (ALVD) or stage C (CHF) according to ACC/AHA classification were studied. LVEF was determined in standard echocardiography with Simpson's method. Pts were divided into four groups: I--stage B and LVEF 40% (52 pts); III--stage C and LVEF 40% (35 pts). The pts were followed for 30 months for the occurrence of the composite endpoint: major acute coronary events (MACE) i.e: ACS and cardiovascular deaths (CVD). In analysis we used chi2 test. RESULTS: There were 35 MACE during follow-up: 30 in pts in stage C and 5 in stage B. There were more MACE in group I than in group III (p < 0.01) and in group II than in group IV (p < 0.001). Pts in group I had more MACE than in group IV (p < 0.05). There were more MACE in group II than in group III (p < 0.01). Other results were not statistically significant. CONCLUSIONS: Stage of heart failure evaluated clinically is more powerful predictor of MACE than decreased LVEF. The more advanced stage of heart failure in post-MI pts, the higher risk of ACS or CVD. LVEF does not influence the risk of MACE in pts in the same stage of heart failure.