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Circulation, Vol 67, 330-334, Copyright © 1983 by American Heart Association
MA Warnowicz, H Parker and MD Cheitlin
To assess the prognostic importance of resting left ventricular function in
survivors of acute myocardial infarction with pulmonary edema, we
retrospectively identified 39 consecutive patients who presented with acute
pulmonary edema and myocardial infarction. Sixteen patients had
radionuclide ejection fractions 10 +/- 2 days postinfarction of greater
than 0.45 (group A, mean 0.55 +/- 0.06), and 23 patients had ejection
fractions less than or equal to 0.45 (group B, 0.32 +/- 0.06). There were
no significant differences between the two groups for age or sex, but group
A patients had a significantly greater incidence of first myocardial
infarction predominantly inferior in location. The calculated stroke work
index during the acute event was significantly greater in group A than in
group B (33.4 +/- 2.4 vs 23.4 +/- 2.0) (p less than 0.05). During a
follow-up of 9 +/- 3 months, mortality was not significantly different
between the two groups: Four (25%) died in group A and seven (30%) died in
group B. In addition, eight patients (50%) in group A were hospitalized for
recurrent angina, new myocardial infarction or recurrent pulmonary edema,
compared with 11 (48%) in group B (NS). Three deaths in group A were
preceded by infarction of the anterior wall of the left ventricle,
confirmed at autopsy, and two nonfatal infarctions were anterior by
electrocardiography. Four patients in group A had coronary arteriography
performed during the follow-up period because of unstable angina, and all
had significant (greater than or equal to 70% stenosis) three-vessel
disease and two had left main coronary artery disease. Therefore, the
predischarge ejection fraction did not predict prognosis for this group of
patients. Patients with acute pulmonary edema in the course of myocardial
infarction form a high-risk group despite good resting left ventricular
function at discharge. They have a significant incidence of recurrent
myocardial infarction and death and, because they have good residual left
ventricular function, are excellent candidates for surgical intervention.
ARTICLES
Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction
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