Analysis Of Clinical Factors For Improvement Of Ejection Fraction In AMI Patients Combined With HFrEF

OBJECTIVE:To investigate the clinical factors affecting the improvement of Left ventricular ejection fraction(Left ventricular ejection fraction,LVEF)in AMI(Acute myocardial infarction,AMI)patients combined with HFrEF(Heart failure with reduced ejection fraction,HFrEF)Methods.1.A total of 2677 patients diagnosed with AMI in Jilin University Bethune First Hospital between December 2020 and December 2021 were retrospectively collected,and 60 all-cause deaths were excluded,after which a total of 250 patients with LVEF≤40%measured by echocardiography within 72 hours of admission were screened,and patients who did not have outpatient or inpatient follow-up cardiac ultrasound within 3-6 months were excluded,and all patients were collected 3-6 months after discharge.After strict inclusion and exclusion criteria,a total of 110 patients were eligible and were divided into improvement group(Group A)and non-improvement group(Group B)based on whether the LVEF improved to 50%within 3-6 months of follow-up.There were 41 patients in group A and 69 patients in group B.2.Baseline information of the patients was collected through the Haitai electronic medical record system,including general information,past medical history,laboratory indexes,coronary angiography information,echocardiography-related indexes,out-ofhospital medication use and follow-up echocardiography data within 3-6 months.The clinical data of patients in the EF improvement group(Group A)and EF nonimprovement group(Group B)were compared.3.In this study,the relevant data were collected and organized by EXCEL,and SPSS 27.0 was used for statistical analysis.In this study,continuous variables were described by(X±S)for those with normal distribution and t-test for two independent samples for comparison between groups;median and quartile M(P25,P75)for those with non-normal distribution and Mann-Whitney U test for comparison between groups;categorical variables were expressed as cases(%)and chi-square test or Fisher exact probability method was used for comparison between groups.A binary logistic regression model was used to analyze the factors affecting LVEF improvement,and variables with single-factor P<0.05 and variables that might be significant were screened for inclusion in the multifactor regression model for analysis.Differences were considered statistically significant at P<0.05.Results.1.Univariate analysis:Patients in the EF improvement group had a higher basal LVEF,a higher proportion of patients who underwent PCI,a lower proportion of patients with a previous history of AMI or who underwent revascularization,a lower BNP level,a lower proportion of patients who took spironolactone and furosemide after discharge,and smaller LAd,LVEDd,ESV,and EDV values,and the differences between the two groups for the above factors were statistically significant(P<0.05))2.Multi-factor logistic regression analysis showed that PCI(OR=3.663,95%CI 1.294-10.368);ESV(OR=0.979,95%CI 0.966-0.993)was an independent factor influencing the improvement of LVEF.Conclusion.In patients with AMI combined with HFrEF not treated with PCI surgery,low basal EF,high BNP levels,previous MI,history of previous revascularization,large LAd values,large LVEDd values,large ESV values,large EDV values,and post-discharge administration of furosemide and spironolactone,LVEF is less likely to improve within 3-6 months.In patients with AMI combined with HFrEF,undergoing PCI is an independent protective factor for LVEF improvement and ESV value is an independent risk factor for LVEF improvement.