Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)

Background: Abnormal left ventricular systolic and diastolic function and reduced exercise capacity are associated with worse prognosis following ST-elevation myocardial infarction (STEMI). However, evidence is lacking on the determinants of exercise capacity following STEMI. We sought to determine...

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Autores principales:	Harry Klimis, Aaisha Ferkh, Paula Brown, Robert Zecchin, Mikhail Altman, Liza Thomas
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	STEMI myocardial infarction diastolic function systolic function exercise capacity metabolic equivalents Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/f4f9fff683574041a8335040ddf938e1
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spelling	oai:doaj.org-article:f4f9fff683574041a8335040ddf938e12021-11-25T18:00:14ZDeterminants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)10.3390/jcdd81101402308-3425https://doaj.org/article/f4f9fff683574041a8335040ddf938e12021-10-01T00:00:00Zhttps://www.mdpi.com/2308-3425/8/11/140https://doaj.org/toc/2308-3425Background: Abnormal left ventricular systolic and diastolic function and reduced exercise capacity are associated with worse prognosis following ST-elevation myocardial infarction (STEMI). However, evidence is lacking on the determinants of exercise capacity following STEMI. We sought to determine the impact of systolic and diastolic dysfunction on exercise capacity and outcomes following first-ever STEMI. Methods: In a retrospective analysis of 139 consecutive STEMI patients who had a transthoracic echocardiogram following STEMI and completed exercise treadmill testing, the primary outcome was to identify clinical and echocardiographic determinants of exercise capacity, and the secondary outcome was to identify determinants of major adverse cardiac events (MACEs). Results: Mean number of metabolic equivalents (METs > 8) was used as a cut-off. Age, female sex, anterior infarction, abnormal diastolic function, minimum left atrial indexed volume (LAVI<sub>min</sub>) ≥ 18 mL/m<sup>2</sup>, average e’, and E/e’ were associated with METs ≤ 8, but not left ventricular ejection fraction (LVEF). On multivariate analysis, LAVI<sub>min</sub> (OR 4.3, 95%CI 1.3–14.2; <i>p</i> = 0.017), anterior infarction (OR 2.6, 95%CI 1.2–5.9; <i>p</i> = 0.022), and abnormal diastolic function (OR 3.73, 95%CI 1.7–8.4; <i>p</i> = 0.001) were independent predictors of METs ≤ 8. On Kaplan–Meier analysis, METs ≤ 8 (<i>p</i> = 0.01) and abnormal diastolic function (<i>p</i> = 0.04) were associated with MACEs (median follow-up 2.3 years). METs ≤ 8 was an independent predictor of MACEs (HR 3.4, 95%CI 1.2–9.8; <i>p</i> = 0.02). Conclusions: Following first-ever STEMI, increased LAVI<sub>min</sub>, anterior infarction, and abnormal diastolic function were independent predictors of reduced exercise capacity. Furthermore, reduced exercise capacity was an independent predictor of MACEs. These results highlight important prognostic and therapeutic implications related to abnormal diastolic function in STEMI patients that are distinct from those with LV systolic impairment.Harry KlimisAaisha FerkhPaula BrownRobert ZecchinMikhail AltmanLiza ThomasMDPI AGarticleSTEMImyocardial infarctiondiastolic functionsystolic functionexercise capacitymetabolic equivalentsDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Cardiovascular Development and Disease, Vol 8, Iss 140, p 140 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	STEMI myocardial infarction diastolic function systolic function exercise capacity metabolic equivalents Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	STEMI myocardial infarction diastolic function systolic function exercise capacity metabolic equivalents Diseases of the circulatory (Cardiovascular) system RC666-701 Harry Klimis Aaisha Ferkh Paula Brown Robert Zecchin Mikhail Altman Liza Thomas Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
description	Background: Abnormal left ventricular systolic and diastolic function and reduced exercise capacity are associated with worse prognosis following ST-elevation myocardial infarction (STEMI). However, evidence is lacking on the determinants of exercise capacity following STEMI. We sought to determine the impact of systolic and diastolic dysfunction on exercise capacity and outcomes following first-ever STEMI. Methods: In a retrospective analysis of 139 consecutive STEMI patients who had a transthoracic echocardiogram following STEMI and completed exercise treadmill testing, the primary outcome was to identify clinical and echocardiographic determinants of exercise capacity, and the secondary outcome was to identify determinants of major adverse cardiac events (MACEs). Results: Mean number of metabolic equivalents (METs > 8) was used as a cut-off. Age, female sex, anterior infarction, abnormal diastolic function, minimum left atrial indexed volume (LAVI<sub>min</sub>) ≥ 18 mL/m<sup>2</sup>, average e’, and E/e’ were associated with METs ≤ 8, but not left ventricular ejection fraction (LVEF). On multivariate analysis, LAVI<sub>min</sub> (OR 4.3, 95%CI 1.3–14.2; <i>p</i> = 0.017), anterior infarction (OR 2.6, 95%CI 1.2–5.9; <i>p</i> = 0.022), and abnormal diastolic function (OR 3.73, 95%CI 1.7–8.4; <i>p</i> = 0.001) were independent predictors of METs ≤ 8. On Kaplan–Meier analysis, METs ≤ 8 (<i>p</i> = 0.01) and abnormal diastolic function (<i>p</i> = 0.04) were associated with MACEs (median follow-up 2.3 years). METs ≤ 8 was an independent predictor of MACEs (HR 3.4, 95%CI 1.2–9.8; <i>p</i> = 0.02). Conclusions: Following first-ever STEMI, increased LAVI<sub>min</sub>, anterior infarction, and abnormal diastolic function were independent predictors of reduced exercise capacity. Furthermore, reduced exercise capacity was an independent predictor of MACEs. These results highlight important prognostic and therapeutic implications related to abnormal diastolic function in STEMI patients that are distinct from those with LV systolic impairment.
format	article
author	Harry Klimis Aaisha Ferkh Paula Brown Robert Zecchin Mikhail Altman Liza Thomas
author_facet	Harry Klimis Aaisha Ferkh Paula Brown Robert Zecchin Mikhail Altman Liza Thomas
author_sort	Harry Klimis
title	Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
title_short	Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
title_full	Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
title_fullStr	Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
title_full_unstemmed	Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)
title_sort	determinants of exercise capacity following st-elevation myocardial infarction (stemi)
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/f4f9fff683574041a8335040ddf938e1
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Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI)

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