Variable spectrum and prognostic implications of left and right ventricular ejection fractions in patients with and without clinical heart failure after acute myocardial infarction

To determine the spectrum and prognostic implications of left and right ventricular (LV and RV) ejection fractions (EFs) in acute myocardial infarction (AMI), radionuclide ventriculography was performed in 114 consecutive patients, admitted without (Killip class I, 78 patients) or with (Killip class II, 36 patients) clinical signs of pulmonary congestion within 24 hours of onset of symptoms of a transmural AMI. Mean LVEF was significantly lower in patients in Killip class II than in those in class I (0.32 ± 0.11 vs 0.46 ± 0.15, p < 0.001) and in patients with anterior than inferior AMI (0.34 ± 0.11 vs 0.52 ± 0.14, p < 0.001). Of the 36 patients with a severely depressed (0.30 or less) LVEF, 15 (42%) were in Killip class I. Mean RVEF did not differ significantly between Killip class I and II patients (0.42 ± 0.11 vs 0.40 ± 0.12, difference not significant) but was significantly lower in patients with inferior than anterior AMI (0.38 ± 0.09 vs 0.44 ± 0.11, p = 0.005). In patients with inferior AMI, a depressed RVEF (0.38 or less) was associated with a normal LVEF in 30% and a depressed LVEF in 20%, whereas in those with anterior AMI, a depressed RVEF, observed in 25% of patients, occurred only in association with a depressed LVEF. At 1 year of follow-up, the 21 nonsurvivors differed significantly from the 93 survivors with respect to LVEF (0.35 ± 0.11 vs 0.45 ± 0.14, p < 0.001), RVEF (0.35 ± 0.11 vs 0.43 ± 0.10, p = 0.006), proportion in Killip class II (57 vs 28%, p = 0.02) and age (69 ± 13 vs 61 ± 11 years, p = 0.01). Mortality rate was 47% in patients with an LVEF of 0.30 or less (group I) compared with 5% in patients with an LVEF greater than 0.30 (group II, p < 0.001). In group I patients, the mortality rate was 75% when RVEF was 0.38 or less, compared with 25% when RVEF was more than 0.38 (p < 0.001). An RVEF of less or greater than 0.38 did not influence mortality in group II patients. Multivariate analysis identified LVEF of 0.30 or less, RVEF 0.38 or less and age as significant independent predictors of mortality. These results show the wide variability in global ventricular function among a subset of patients with AMI with clinical evidence of no or only mild LV failure. They also show independent and additional adverse prognostic implications of a depressed RVEF among a subset of patients with severely depressed LVEF (0.30 or less).