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

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

Author information

1
Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany.
2
Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
3
Department of Cardiology and Angiology, Ernst von Bergmann Hospital, Potsdam, Germany.
4
Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany. karl.wegscheides@t-online.de.
5
Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Ruedersdorf, Berlin, Germany. karl.wegscheides@t-online.de.
6
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

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

PMID:
28679419
PMCID:
PMC5498920
DOI:
10.1186/s13104-017-2562-4
[Indexed for MEDLINE]
Free PMC Article

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