A Clinical Rule To Predict Preserved Left Ventricular Ejection Fraction in Patients after Myocardial Infarction

  1. Marc T. Silver, MD;
  2. Geoffrey A. Rose, MD;
  3. Sumita D. Paul, MD, MPH;
  4. Christopher J. O'Donnell, MD;
  5. Patrick T. O'Gara, MD; and
  6. Kim A. Eagle, MD
  1. From Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, Massachusetts. Requests for Reprints: Patrick T. O'Gara, MD, Cardiac Unit, Ambulatory Care Center 475, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114. Acknowledgments: The authors thank Ms. Shirley Thomas and Dr. Michael Picard for assistance in the preparation of this manuscript.

    Abstract

    Objective: To derive and validate a clinical prediction rule that identifies patients after myocardial infarction who have preserved left ventricular systolic function.

    Design: Retrospective analysis of a prospective cohort study, with a derivation set to generate a clinical prediction rule and a validation set to test the prediction rule.

    Setting: Urban tertiary care hospital.

    Patients: 314 consecutive patients admitted with myocardial infarction who had one or more of the following tests to determine left ventricular ejection fraction: transthoracic echocardiography, contrast left ventriculography, or radionuclide ventriculography.

    Measurements: Left ventricular ejection fractions were determined by transthoracic echocardiography, contrast left ventriculography, and gated blood pool scan.

    Results: Multivariate analysis of patients in the derivation set yielded the following rule: The left ventricular ejection fraction is predicted to be 40% or more in patients who have 1) an interpretable electrocardiogram, 2) no previous Q-wave myocardial infraction, 3) no history of congestive heart failure, and 4) an index myocardial infarction that is not a Q-wave anterior infarction. In the derivation and the validation sets, the positive predictive value of the prediction rule was more than 0.98.

    Conclusions: A simple clinical prediction rule using easily obtained historical and electrocardiographic data reliably identifies a substantial percentage of patients after myocardial infarction (40% in our hospital) who are likely to have preserved left ventricular systolic function. If validated in other patient populations, application of this prediction rule in clinical practice could result in a substantial decrease in the cost of treating uncomplicated myocardial infarction.

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    1. Ann Intern Med November 15, 1994 vol. 121 no. 10 750-756
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