The relationship between hemoglobin level on admission and left ventricular systolic function in patients with first st elevating myocardial infarction.

Acute myocardial infarction is the leading cause of death worldwide and in our country. Poor prognosis and death after acute myocardial infarction is strongly associated with the degree of left ventricular systolic dysfunction. Systolic dysfunction occurs due to myocardial necrosis caused by prolonged ischemia. The degree of ischemia after total coronary occlusion is affected by multiple intra and extracardiac factors such as heart rate, blood pressure, myocardial contractility, the degree of inflammation and anemia. The purpose of our study; was to evaluate the possible contribution of anemia - detected at initial admission to coronary intensive care unit on to the degree of systolic dysfunction in patients with first ST elevating myocardial infarction by using echocardiography. For this purpose we included 482 patients between 24-74 years of age (mean 56,5±11,2). Among them 402 (%83) were male and 80 (%17) were female. The echocardiographic examination was made as soon as the clinical stability of the patients were achieved after admission to coronary intensive care unit (mean 2.4 days). Left ventricular systolic functions were assesed by ejection fraction (EF) determined with modified Simpson method , wall motion score index (WMSI) calculated according to American Echocardiography Association Model taking 16 left ventricular segments into account and by tissue doppler S wave velocities measured from different localisations in left ventricle. 52 The mean EF of the patients included was 48.4±9.5 %. It was 47.5±8.3% in the anemic group and 48.5±9.75% in patients witout anemia.The mean EF in the anemic group was lower than the patients witout anemia but this difference did not reach statistical significance (p=0.46). The mean WMSI was 1.58 ±0.35. It was 1.59 ±0.38 in the anemic group whereas 1.58 ±0.35 in patients without anemia (p=0.78). We found that mild to modarate anemia did not effect EF or WMSI significantly during the course of acute myocardial infarction. To find out the impact of anemia on Sm velocities pulse wave doppler cursor was located on anterior, inferior, lateral and septal mitral annular localisations and each Sm velocity was recorded. The Sm velocities was lower in the anemic group globally but only septal mitral annular Sm velocities reached statistical significance (5.9±1.6 vs 6.36±1.7; p=0.048). Despite this finding we thougt that this difference is not enough to establish the unfavorable effect of anemia on systolic function. In our study we found that mild to moderate anemia did not have an unfavorable effect on left ventricular systolic function during the course of acute myocardial infarction. However it has already been shown that anemia during the course of acute myocardial infarction is related with short and long term major adverse clinical events and mortality.The cause of this fact might be any other reason than the detrimental effect of anemia on left ventricular systolic function.