Predictors of acute heart failure in patients during the acute period of Q-wave myocardial infarction
DOI:
https://doi.org/10.14739/2310-1210.2019.2.161319Keywords:
myocardial infarction, heart failure, prognosisAbstract
The aim was to identify predictors of acute heart failure (AHF) in patients with acute Q-wave myocardial infarction (MI).
Materials and methods. A total of 139 patients in the acute period of Q-wave MI were examined, average age was 66.00 ± 0.97 years (M ± m). Patients were divided into 2 groups depending on AHF presence: without AHF – 46 persons, the mean age was 61.00 ± 1.87 years (M ± m) and with developed AHF – 93 persons (Killip II, n = 51; Killip III, n = 42), the mean age was 69.2 ± 8.3 years (M ± m). The patients underwent general clinical examination, blood glucose level was determined on admission, transthoracic Doppler echocardiography was performed and copeptin and NTproBNP levels were measured.
Results. According to univariate logistic regression analysis, hyperglycemia in the acute period of Q-wave MI was associated with a probable increase in the odds ratio of AHF by 1.24 times (95 % CI 1.08–1.44; P = 0.003). According to the results of the ROC-analysis, the critical level of glycemia was >9.3 mmol/l (sensitivity 47.8 %, specificity 78.3 %), the area under the ROC-curve was 0.666 (95 % CI 0.580–0.745; P = 0.0004). With the development of systolic dysfunction in the acute period of MI, the odds ratio of AHF increased by 5.69 times (95 % CI 2.47–13.14; P < 0.0001). An increase in copeptin level of more than 0.53 ng/ml (sensitivity 93.1 %, specificity 28.6 %) and the area under the ROC curve of 0.633 (95 % CI 0.543–0.716; P = 0.0086) were associated with an increase in the odds ratio of AHF by 1.39 times (95 % CI 1.06–1.83; P = 0.02). There was no dependence of AHF on NTproBNP level – OR = 1.001 (95 % CI 0.99–1.01; P = 0.36). According to multivariate logistic regression analysis, independent risk factors for AHF were the hyperglycemia level on admission of more than 9.3 mmol/l OR = 1.19 (95 % CI 1.01–1.39; P = 0.036) and left ventricular (LV) systolic dysfunction – OR = 5.24 (95 % CI 2.03–13.55; P = 0.001).
Conclusions. In patients with acute Q-wave MI complicated by AHF, the admission levels of copeptin and glycemia were significantly higher andLV ejection fraction was significantly lower. The dependent risk factors for AHF in patients with acute Q-wave MI were glycemia level of more than 9.3 mmol/l, an increase in copeptin level of more than 0.53 ng/ml, andLV systolic dysfunction. Independent risk factors for AHF in the acute period Q-wave MI were hyperglycemia andLV systolic dysfunction.
References
Parkhomenko, O.M., & Kozhukhov, S. M. (2014) Hostra sertseva nedostatnist u khvorykh na hostryi infarkt miokarda z elevatsiieiu sehmenta ST na EKH [Acute heart failure in patients with acute myocardial infarction with ST elevations on ECG]. Medicina neotlozhnykh sostoyanij, 3(58), 28–33. [in Ukrainian].
Steg, P. G., James, S. K., Atar, D., Badano, L. P., Blömstrom-Lundqvist, C., Borger, M. A., et al. (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur. Heart J., 33(20), 2569–2619. doi: 10.1093/eurheartj/ehs215.
Lang, R. M. Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1–39. doi: 10.1016/j.echo.2014.10.003.
Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B., et al. (2009) American association of clinical endocrinologists and american diabetes association consensus statement on inpatient glycemic control. Diabetes Care, 32(6), 1119–1131. doi: 10.2337/dc09-9029
Myftiu, S., Bara, P., Sharka, I., Shkoza, A., Belshi, X., Rruci, E., & Vyshka, G. (2016) Heart Failure Predictors in a Group of Patients with Myocardial Infarction. Open Access Maced J Med Sci, 4(3), 435–438. doi: 10.3889/oamjms.2016.101
Parkhomenko, O. M., Gurjeva, O. S., Kornatskyi, Yu. V., Kozhukhov, S. M., Lutay, Ya. M., & Irkin, O. I. (2012) Perebih zakhvoriuvannia u khvorykh iz hostrym koronarnym syndromom iz elevatsiieiu sehmenta ST ta zberezhenoiu fraktsiieiu vykydu livoho shlunochka [Clinical course of STEMI in patients with preserved LV function: is extent of myocardial damage a main determinant of adverse outcomes?]. Ukrainskyi medychnyi chasopys, 3(89), 118–123. [in Ukrainian].
Auffret, V., Leurent, G., Gilard, M., Hacot, J. P., Filippi, E., Delaunay, R., et al. (2016) Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention. International Journal of cardiology, 221, 433–42. doi: 10.1016/j.ijcard.2016.07.040.
Patwary, I., Rahman, M., & Shahabuddin (2013) Fasting glycaemia is a predictor of outcome after acute myocardial infarction. Bangabandhu Sheikh Mujib Medical University Journal, 6(2), 135–140. doi: 10.3329/bsmmuj.v6i2.29129
Smith, G. L., Masoudi, F. A., Shlipak, M. G., Krumholz, H. M., & Parikh, C. R. (2008) Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction. J. Am. Soc. Nephrol, 19(1), 141–150. doi: 10.1681/ASN.2007050554
Iermak, A. S., Kravchun, P. G., & Ryndina, N. G. (2015) Alhorytm prohnozuvannia rozvytku hostroi sertsevoi nedostatnosti u khvorykh na hostryi infarkt miokarda iz suputnim ozhyrinniam iz urakhuvanniam rivniv kopeptynu, MRproADM, troponinu I ta parametriv lipidnoho obminu [Prediction algorithm of acute heart failure development in patients with acute myocardial infarction accompanied with obesity according to the level of copeptin, MRproADM, troponin I and lipid metabolism’s parameters]. Problemy endokrynnoi patolohii, 2, 28–34. [in Ukrainian].
Kelly, D., Squire, I. B., Khan, S. Q., Quinn, P., Struck, J., Morgenthaler, N. G., et al. (2008) C-terminal provasopressin (copeptin) is associated with left ventricular dysfunction, remodeling, and clinical heart failure in survivors of myocardial infarction. J Card Fail, 14(9), 739–45. doi: 10.1016/j.cardfail.2008.07.231
Zhukova, A. V., & Arabidze, G. G. (2017) Diagnosticheskoe znachenie kopeptina v verifikacii nekroza miokarda u pacientov s ostrym koronarnym sindromom bez pod"yema segmenta ST v pervye 3 chasa ot manifestacii bolevogo sindroma [Diagnostic value of copeptin in verification of myocardial necrosis in patients with acute coronary syndrome without ST-segment elevation in the first 3 hours after manifestation of pain syndrome]. Rossijskij medicinskij zhurnal, 25(20), 1404–1408. [in Russian].
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., et al. (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 37(27), 2129–2200. doi: 10.1093/eurheartj/ehw128
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