Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction

Authors

  • Vijay Kumar Verma Department of Medicine, Uttar Pradesh Rural Institute of Medical Sciences & Research, Saifai, Etawah, U.P.
  • Ramakant Rawat Department of Medicine, Uttar Pradesh Rural Institute of Medical Sciences & Research, Saifai, Etawah, U.P.
  • Vidya Sagar Department of Medicine, Uttar Pradesh Rural Institute of Medical Sciences & Research, Saifai, Etawah, U.P.
  • Granth Kumar Department of Medicine, Uttar Pradesh Rural Institute of Medical Sciences & Research, Saifai, Etawah, U.P.

Keywords:

Acute myocardial infarction, Left ventricle, Ejection-fraction, Diabetes mellitus, Hypertension, Dyslipidemia, smoking, Cardiovascular risk factors

Abstract

Background: Objectives of current study were to determine the magnitude of left ventricular systolic dysfunction in patients with acute myocardial infarction in the rural sub-population of Uttar Pradesh in India and to evaluate the impact of cardiovascular risk factors on the risk of impairment of left ventricular systolic function.

Methods: One hundred and fifty seven consecutive patients with first acute myocardial infarction were enrolled into the study. Most patients were male (73.2%) and the mean age of presentation was 52.7 years. Two dimensional echocardiography was utilized to assess conventional parameters such as Left Ventricular End-Diastolic Diameter (LVEDD), Left Ventricular End-Systolic Diameter (LVESD), LV End-Diastolic Volume (LVEDV), LV End-Systolic Volume (LVESV) and Left Ventricular Ejection Fraction (LVEF). The LV volumes (end-systolic and end-diastolic) and LVEF were calculated from the conventional apical two-and four-chamber images using the biplane Simpson’s technique. LV systolic function was considered depressed when LVEF was less than 45%. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was used to assess the independent effect of the each variable.

Results:The study projects a high proportion (42.7% of the patient population) of left ventricular systolic dysfunction in patients with Acute Myocardial Infarction (AMI). No association was found between gender or age and LV systolic dysfunction. The proportion of patients with diabetes mellitus was higher in the sub-group of patients with impaired LV systolic function (45.2% vs. 30.2%, P = 0.01); the proportion of patients with history of current or past smoking was also higher in the sub-group of patients with impaired LV systolic function (48.9% vs. 34.2%, P = 0.03). On the other hand, hypertension and dyslipidemia were not associated with impaired LVEF. After adjustment of other variables, diabetes and smoking were associated with a significantly higher risk of LV systolic dysfunction (diabetes: OR = 3.73; 95% CI = 1.25-11.16; smoking: OR = 3.8; 95% CI = 1.37-11.05).

Conclusion:Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis.

 

References

White HD, Norris RM, Brown MA, Brandt PWT, Whitlock RML, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76:44-51.

Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling. J Am Coll Cardiol. 2000;35:569-82.

Sanz G, Castaner A, Betriu A, Magrina J, Roig E, Coil S, et al. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med. 1982;306:1064.

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American college of cardiology/American heart association task force on practice guidelines (Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation. 2004 Aug;110(5):588-636.

Solomon SD, Anavekar NS, Greaves S, Rouleau JL, Hennekens C, Pfeffer MA. Angina pectoris prior to myocardial infarction protects against subsequent left ventricular remodeling. J Am Coll Cardiol. 2004;43(9):1511-4.

Hochholzer W, Buettner HJ, Trenk D, Laule K, Christ M, Neumann FJ, et al. New definition of myocardial infarction: impact on long-term mortality. Am J Med. 2008;121(5):399-405.

Ishiara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nishioka K, et al. Impact of acute hyperglycemia on left ventricular function after reperfusion therapy in patients with a first anterior wall acute myocardial infarction. Am Heart J. 2003;146(4):674-8.

American Diabetes Association. Standards of medical care in diabetes-2014. Diabet Care. 2014 Jan;37(Suppl 1):S14-80.

Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. N Engl J Med. 1999;339:229-34.

Andrikopoulos GK, Richter DJ, Dilaveris PE, Pipilis A, Zaharoulis A, Gialafos JE, et al. In-hospital mortality of habitual cigarette smokers after acute myocardial infarction. Eur Heart J. 2001;22:776-84.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr. 2005;18(12):1440.

Sulfi S, Timmis A. Heart failure complicating acute myocardial infarction in patients with diabetes: pathophysiology and management strategies. Br J Diabet Vasc Dis. 2006;6(5):191-6.

Santoro F, Tramarin R, Colombo E, Agricola P, Picozzi A. Evaluation of regional left ventricular wall motion with color kinesis: comparison with two-dimensional echocardiography in patients after acute myocardial infarction. G Ital Cardiol. 1998 Sep;28(9):984-95.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.

Henareh L, Lind B, Brodin LA, Agewall S. Disturbed glucose metabolism is associated with left ventricular dysfunction using tissue Doppler imaging in patients with myocardial infarction. Clin Physiol Funct Imaging. 2007 Jan;27(1):60-6.

Villarreal FJ, Hong D, Omens J. Nicotine-modified post-infarction left ventricular remodeling. Am J Physiol Heart Circ Physiol. 1999;276:H1103-6.

Ottervanger JP, van’t Hof AWJ, Reiffers S, Hoorntje JCA, Suryapranata H, de Boer MJ, et al. Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction. Eur Heart J. 2001;22:785-90.

Downloads

Published

2017-01-24

How to Cite

Verma, V. K., Rawat, R., Sagar, V., & Kumar, G. (2017). Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction. International Journal of Research in Medical Sciences, 2(3), 1101–1106. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/2361

Issue

Section

Original Research Articles