In:
European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 12, No. Supplement_1 ( 2023-05-03)
Abstract:
Type of funding sources: None. Background Aadverse left ventricle remodeling’s natural evolution without proper therapy leads to low left ventricle ejection fraction (LVEF) and high morbidity and mortality. LVEF evolution after discharge in patients with de novo LV dysfunction (≤40%) detected during an intensive cardiac care unit (ICCU) hospitalization is not well known. Purpose To characterize LVEF evolution after discharge in patient with de novo LV dysfunction (≤40%) detected during an Intensive Cardiac Care Unit (ICCU) admission according to etiology: ischemic etiology (IE)Vs non-ischemic etiology (NIE). Methods We retrospectively analyzed clinical, echocardiographyc, pharmacological and coronary angiography -related variables from 154 consecutive patients admitted from May 2020 to July 2022 in the ICCU of a tertiary hospital and whose LVEF at discharge was ≤40%. Patients were grouped according to LV dysfunction etiology in ischemic and non-ischemic. LVEF at follow-up was registered when available. Results This cohort had a mean age of 64.8 ±14 years and 127 (82%) were male. Mean left ventricle ejection fraction was 30 ±6.8%. Among them, 119 (77%) had ischemic etiology (IE) and 35 (23%) non-Ischemic (NIE). Inotropes during admission were required in 29 (19%) and 151 (98%) were studied with coronary angiography. 70 (46%) were also studied with MRI during hospitalization; 35 (23%) had right ventricular dysfunction (RVD) and 39 (25%) had any kind of bundle branch block at discharge’s EKG. At discharge, 121 (78%) received betablockers (BB), 69 (45%) received Angiotensin Converser Enzyme Inhibitor (ACEI), 17 (11%) received Angiotensin Receptor Blocker (ARB), 24 (16%) received sacubitril-valsartan (ARNI), 88 (57%) received Mineralcorticoid Receptor Antagonist (ARM) and 39 (25%) received Sodium-Glucos type-2 inhibitors. At discharge, LVEF in patients with IE was 31 ±6% and 27 ±8% in NIE (p=0,01). Follow-up echocardiography was available in 119 (77%) of them. Mean last available follow-up LVEF was 46% ±11 in NIE while among IE was 40% ±11 (p=0,02). LVEF increase was of 17±11% in NIE and 9±9% in IE (p=0,0004). Among all, 36 patients normalized LVEF, 14 (50%) in NIE group and 22 (25%) in IE (P=0.01). In a multiple linear regression model adjusting by age, sex, QRS duration, left bundle branch block, TRC implantation and modifying-disease drugs, NIE etiology was independently associated with a 7,6% increase in LVEF compared to IE (p=0,003). Conclusions Our findings support that LVEF improvement after admission to ICCU with de novo LV dysfunction is strongly dependent on etiology. Patients with NIE tend to have an initial worse LVEF but greater improvement at follow-up.
Type of Medium:
Online Resource
ISSN:
2048-8726
,
2048-8734
DOI:
10.1093/ehjacc/zuad036.024
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
2663340-1
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