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Is low diffusion lung capacity a predictor for cardiac remodeling?
1Research Institute for Complex Issues of Cardiov. Dis. - Siberian Branch RAMS Institution Scientific - Kemerovo - Russian Federation
2Kemerovo Cardiology Centre, Emergency Cardiology Department #1 - Kemerovo - Russian Federation
Cardiac remodeling after myocardial infarction remains a frequent complication and, despite recent advances in acute coronary syndrome treatment, in some cases, seems unavoidable. There is evidence that cardiac remodeling is associated with myocardial damage size, coronary arteries patency, coronary revascularization, or inflammation status but a few data exist that explain interconnection between diffusion lung capacity and cardiac remodeling. So, our hypothesis is that low diffusion lung capacity is a predictor for cardiac remodeling in one year after myocardial infarction.
Methods. Patients with ST elevated myocardial infarction hospitalized within 24 hours from symptoms onset were included in the study. Diffusion capacity of lung for carbon monoxide (DLCO) was measured on 10th to 14th days after a patient had been admitted to the hospital. Transthoracic cardiac echo was done on 10th hospital stay day and in one year after myocardial infarction. The statistical analysis was done with statistical software package SPSS for Windows, version 13.0 (SPSS Inc., USA). Factors independently associated with cardiac remodeling were determined with the discriminant analysis. A logistic regression analysis was done to see if a low DLCO was an independent predictor for cardiac remodeling. A p<0.05 was considered statistically significant.
Results. 107 patients (mean age 56.1±9.3 yrs) were included in the study, of which 88 (82%) males. In one year after myocardial infarction, 31 patients (29.0%) developed cardiac remodeling. Univariate analysis showed that early (by 10th hospital stay day) cardiac remodeling, patients’ age, body mass index, left ventricle ejection fraction, mean pulmonary artery pressure, low DLCO, number of coronary arteries with stenosis >50%, and inflammation status were predictors for cardiac remodeling. Discriminant analysis revealed that independent predictors for cardiac remodeling were low DLCO, early myocardial remodeling, and number of coronary arteries with stenosis >50% (Wilks' Lambda 0.47, ?<0.001). This model allowed 88.5% of cases to be correctly classified with area under the ROC-curve 0.84 (95% confidence interval 0.73 to 0.95, p<0.001). A logistic regression analysis showed that, after adjustment for all possible confounding factors, low DLCO increases possibility for cardiac remodeling to be seen with odds ratio 13.8 (95% confidence interval 2.1 to 91.8, p=0.007).
Conclusions: our data showed that cardiac remodeling in one year after myocardial infarction could be associated with low diffusion lung capacity.
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