Prognostic impact of cardiac dysfunctions in patients with ST-segment elevation myocardial infarction

Background: The incidence and impact of cardiac dysfunctions after ST-segment elevation myocardial infarction (STEMI) are not understood. We aimed to characterize the prevalence of follow-up systolic and diastolic dysfunction and their associations with long-term outcomes after STEMI. Methods and results: This sub-study of the DANAMI-3 trial included 542 patients with STEMI. Cardiac magnetic resonance (CMR)-defined systolic/diastolic impairment was applied to define systolic/diastolic dysfunction. Systolic dysfunction was defined as left ventricular ejection fraction (LVEF) < 50 %, and diastolic dysfunction as peak filling rate/end-diastolic volume (PFR/EDV) ≤ 2.55 by CMR three months after STEMI. The primary outcome was a composite of all-cause mortality and hospitalization for heart failure. Secondary outcomes were individual components of the primary outcome. During a median follow-up of 10.5 years, 103 patients died or were hospitalized for heart failure. A total of 101 and 232 patients had systolic and diastolic dysfunction at three months. Cox regression showed that LVEF was significantly associated with the outcomes, while PFR/EDV was not associated with any outcome. Systolic dysfunction (LVEF<50 %) was associated with the primary endpoint (adjusted hazards ratio [HR] 2.73), all-cause mortality (aHR 2.26), and hospitalization for heart failure (aHR 7.87). The incidences of isolated diastolic dysfunction, isolated systolic dysfunction and both cardiac dysfunctions were 150, 19 and 82. Patients with isolated systolic dysfunction and both dysfunctions were associated with the outcomes. Conclusions: Cardiac dysfunctions derived from CMR-defined systolic/diastolic impairment showed in about half of the three-month STEMI-survivors. Systolic dysfunction regardless of diastolic dysfunction is a significant predictor of long-term outcomes after STEMI.