Predictors of left ventricular systolic function non-recovery after an acute coronary syndrome

Abstract Background Acute coronary syndromes (ACS) often result in left ventricular (LV) dysfunction. Thanks to significant advancements in medical care over the past years, most patients show some degree of LV function recovery over time. However, other may experience progressive adverse remodelling, despite optimal medical treatment. Aim This study aims to evaluate the LV ejection fraction (LVEF) recovery at 12 months in patients with newly reduced LVEF following ACS and to identify predictors of LVEF non-recovery. Methods All patients hospitalized for an ACS between April 2022 and December 2023 were retrospectively identified. Those with reduced LVEF (EF 50%) during the index event and no prior history of LV disfunction were included. LVEF was evaluated during the initial hospitalization and at 12 months. A multivariate logistic regression model was used to identify independent predictors of LVEF non-recovery at 12 months. Results A total of 339 patients with ACS were identified, of whom 135 (41%) patients had newly reduced LVEF and were included. The majority were male (75,6%) with a mean age of 64 years (SD 12,0) and a median LVEF of 41% (IQR 37-45). 65,2% of the patients presented with ST elevation myocardial infarction (STEMI) and 28,1% with non-STEMI; 6,7% were admitted for unstable angina. At 12 months, two-thirds of patients (66,7%) demonstrated LVEF recovery (LVEF ≥50%), while 16,3% had mildly reduced LVEF (40-49%) and 11,1% had LVEF 40%. Overall, the median LVEF significantly increased to 55% (IQR 46-59), p0,001 at 12 months. Patients with persistent LVEF dysfunction (LVEF50%) were more frequently diabetic compared with patients with LVEF recovery (43,2% vs 25,6%, p=0,059). No other significant differences were observed between these two groups. After adjusting for other cardiovascular risk factors, type of ACS at baseline, complete revascularization, adherence to treatment, and participation in cardiac rehabilitation programs, diabetes (OR 4,6, CI 95% 1,4 – 14,9, p=0,01) and previously known coronary artery disease (OR 2,3, CI 95% 1,0 – 5,0, p=0,04) were identified as independent predictors of LVEF non-recovery at one year. Conclusion A significant proportion of patients developed newly reduced LVEF following an ACS. Current treatments enabled a favourable cardiac remodelling with LVEF recovery observed in two-thirds of patients at 12 months. Diabetes and previously known coronary artery disease were independent predictors of LVEF non-recovery at 12 months, possibly indicating low cardiac reserve or microvascular disfunction in these patients.