Exercise ventilation power is valuable for the early prediction of post-acute myocardial infarction late-onset heart failure risk

Abstract Background Heart failure (HF) after acute myocardial infarction (AMI) is associated with poor outcomes inpatients with AMI. However, late-onset HF after AMI is often neglected and there is a deficiency of relevantpredictive indicators, especially those related to exercise. Purpose To explore whether exercise ventilation power (EVP) can be used for early prediction of post-acute myocardial infarction (AMI) late-onset heart failure (HF) risk. Methods A total of 1159 AMI patients were included in the final analysis of this study. The inclusion criteria included the following items: (1) Patients were between 18 and 80 years old. (2) The patient was diagnosed with AMI;(3)Patients did not experience HF during hospitalization or within 1 month after discharge; (4) Patients performed CPET within 1 month after discharge. Patients with interference in obtaining peak systolic blood pressure during CPET or those lost to follow-up were excluded. The patients were divided into two groups according to whether there is heart failure or not: non-heart failure group (n = 1108) and heart failure group (n = 51). The primary observational clinical endpoint of the present investigation was late-onset HF after AMI . Late-onset HF after AMI was defined as the occurrence of HFrEF and HFmEF in patients with AMI more than one month after discharge. Cox regression and Kaplan–Meier curve analysis were used to evaluate the relationship between EVP and late-onset HF after AMI. The receiver operating curve (ROC) analysis was applied to obtain the optimal cut-of value of EVP for predicting late-onset HF after AMI. Results During the mean 32 months of follow-up, the EVP of the late-onset HF group was significantly lower than that of the non-HF group (P0.001). Multivariate Cox regression analysis indicated that high EVP was associated with a reduced post-AMI late-onset HF risk adjusted hazard ratio (HR)=0.600; 95% CI=0.464–0.777, P0.001. ROC curve analysis was performed at each follow-up time point. The optimal EVP cut-off value for predicting post-AMI late-onset HF was 5.0 mmHg. Kaplan–Meier curves revealed that patients with EVP≤5.0 mmHg had greater post-AMI late-onset HF risk than did those with EVP 5.0 mmHg (log rank P0.001). Conclusions This study revealed for the first time that EVP is useful for the early prediction of post-AMI late-onset HF risk. EVP may play a role in cardiovascular risk stratification of the AMI population and may be used to guide precisemanagement for AMI patients.