Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy

BMC Res Notes. 2017 Jul 5;10(1):244. doi: 10.1186/s13104-017-2562-4.

Abstract

Background: Reduced left ventricular ejection fraction (LVEF) ≤30% is the most powerful prognostic indicator for sudden cardiac death (SCD) in patients after myocardial infarction (MI), but there are little data about long-term changes of LVEF after revascularization and the following implantation of a cardioverter defibrillator (ICD).

Methods: We performed a retrospective analysis of 277 patients with reduced LVEF at least 1 month after MI and complete revascularization. Patients (median time post-MI 23.4 months; 74.3% after PCI, 25.7% after CABG were assigned either to group 1 (LVEF <30%) or group 2 (LVEF 30-40%). Biplane echocardiography was redone after a mean follow-up of 441 ± 220 days.

Results: LVEF increased significantly in both two groups (group 1: 26.2 ± 4.8% to 32.4 ± 8.5%; p < 0.001; group 2: 38.2 ± 2.5% to 44.4 ± 9.6%; p < 0.001). However, statistical analysis of first and second LVEF measurement by means of a LOWESS regression and with an appropriate correction of the regression towards the mean effect revealed only a moderate increase of the mean LVEF from 35 to 37% (p < 0.001) with a large interindividual variation.

Conclusions: The impact of early revascularization on LVEF appears to be low in the majority of post-MI heart failure patients. Owing to the high variability, a single measurement may not be reliable enough to justify a decision on ICD indication.

Keywords: Cardioverter-defibrillator; Heart failure; Myocardial infarction; Regression toward the mean.

MeSH terms

  • Aged
  • Death, Sudden, Cardiac / pathology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable*
  • Echocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / pathology
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / surgery*
  • Myocardial Revascularization / methods*
  • Retrospective Studies
  • Stroke Volume*
  • Treatment Outcome
  • Ventricular Function, Left*