Analysis of risk factors and development of prediction model for improvement of ejection fraction in patients with ischemic cardiomyopathy after percutaneous coronary intervention: a case control study

Analysis of risk factors and development of prediction model for improvement of ejection fraction in patients with ischemic cardiomyopathy after percutaneous coronary intervention: a case control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of risk factors and development of prediction model for improvement of ejection fraction in patients with ischemic cardiomyopathy after percutaneous coronary intervention: a case control study Lifang Su, Xianghua Fu, Yanbo Wang, Yunfa Jiang, Yang Fu, Qing Wang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5167990/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: There is a lack of relevant studies investigating left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) following percutaneous coronary intervention (PCI). This study aimed to investigate the factors influencing LVEF improvementafter PCI in patients with ICM. Methods: This single-center, retrospective study included consecutive patients diagnosed with ICM who underwent PCI at the Second Hospital of Hebei Medical University between January 2019 and March 2024. Patients were categorized into two groups based on changes in LVEF. The improved LVEF group included patients with ≥10% improvement, whereas the other group included patients who exhibited <10% improvement or deterioration. Clinical data were compared between the two groups. Univariate and multivariable logistic regression analyses were performed to assess factors affecting LVEF improvement, and nomogram prediction model for 6-month improvement in LVEF were developed based on logistic regression. Results: Overall, 123patients were enrolled in our study, with 52 patients showing ≥10% improvement and 71 patients showing <10% improvement or deterioration. Patients in the improved LVEF group were significantly more likely to have a lower prior myocardial infarction (MI), left ventricular end-diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV), and moderate or severe mitral regurgitation (MR) compared with the non-improved LVEF group. A nomogram predictive model was developed based on prior MI，LVEDD，LVEDV and moderate or severe MR, the AUC of the model is 0.734, indicating good discriminatory ability. The calibration curve and decision curve analysis show that the model has good consistency and clinical application value. Multivariable logistic regression analysis identified two independent factors for LVEF improvement: prior MI and moderate or severe MR. Conclusions: Prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. Prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM. Left ventricular ejection fraction improvement Percutaneous coronary intervention Ischemic cardiomyopathy Figures Figure 1 1 Background Ischemic cardiomyopathy (ICM) is a disease characterized by myocardial degeneration, necrosis, and fibrosis caused by coronary artery disease (CAD), particularly lesions in the left main artery or multiple coronary arteries, leading to severe left ventricular systolic dysfunction 1 , 2 . This dysfunction represents the final stage of CAD and the main cause of heart failure with reduced ejection fraction (HFrEF) 3 , 4 . For patients with ICM, revascularization, primarily involving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), should be considered based on optimal drug treatment 5 , 6 . However, revascularization therapy is not suitable for all patients 7 , 8 . Therefore, an effective method is needed to predict the benefits of revascularization before treatment. Regardless of the cause of HFrEF, improving left ventricular function is the key treatment objective, and left ventricular ejection fraction (LVEF) is an important prognostic factor for patients with HFrEF. Compared with those with sustained reduction in LVEF, patients with improved LVEF experience significantly improved quality of life and reduced incidence of short and long-term adverse cardiovascular events 9 – 13 . A long-term follow-up study of patients after PCI (mean/maximum, 5/14 years) showed that a 5% increase in LVEF was associated with a 6% reduction in mortality and a 10% reduction in hospital length of stay for heart failure 14 . LVEF is also a significant predictor of the long-term prognosis of patients with ICM having revascularization 15 , and guidelines recommend that echocardiography be repeated at least 90 days after revascularization to assess treatment effects and predict outcomes in patients with ICM 16 . However, despite receiving standard drug therapy and revascularization, the proportion of LVEF improvement remains low in patients with ischemic HFrEF 11 . Currently, the underlying mechanisms and factors influencing LVEF improvement in patients with HFrEF remain unclear, and there is a lack of relevant studies investigating LVEF improvement in patients with ICM following PCI, particularly the lack of a clinically applicable prognostic model. Therefore, this study aimed to investigate the factors influencing LVEF improvement in patients with ICM after PCI, and based on the key factors, establish a prognostic model to help clinicians better distinguish patients with poor prognosis. 2 Methods 2.1 Study design and patient population This single-center retrospective study included consecutive patients with ICM who underwent PCI at the Second Hospital of Hebei Medical University between January 2019 to March 2024. This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University. The inclusion criteria were as follows: (1) over 18 years old; (2) patients with coronary angiography showing ≥ 70% stenosis in the main coronary artery and its major branches, with or without stenosis of the left main artery ≥ 50% who underwent PCI during hospitalization; (3) echocardiography indicating regional wall motion abnormalities with LVEF < 50% at admission; (4) participants were required to undergo echocardiography at the 6-month follow-up. The exclusion criteria were as follows: (1) patients with primary myocardiopathy, congenital heart disease, rheumatic heart disease, or other nonischemic myocardial diseases; (2) patients with chronic obstructive pulmonary disease, primary pulmonary hypertension, or other diseases affecting cardiac function; (3) patients who had experienced acute myocardial infarction within 1 month; had a history of CABG; or had received a pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy; (4) patients with acute myocardial infarction, unplanned revascularization, heart valve intervention, heart transplantation, and self-withdrawal of pharmacological treatment within 6 months after discharge. Based on the change in LVEF ([LVEF follow-up] – [LVEF admission]), patients were categorized into two groups: the improved LVEF group, including patients with a ≥ 10% improvement, and the non-improved LVEF group, including patients with < 10% improvement or deterioration. 2.2 Data collection Baseline clinical characteristics of the patients, including demographic data, medical conditions, prescribed medications, laboratory data, echocardiography parameters at admission and 6 months after discharge, and coronary interventional parameters, were collected. Echocardiography was performed independently by two experienced technicians using two-dimensional, targeted M-mode echocardiographs, and Doppler ultrasound measurements were obtained using standard techniques based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Echocardiography parameters assessed included left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV), inter-ventricular septal (IVS), LVEF, early diastolic transmitral velocity to early diastolic mitral annular velocity (E/e’), degree of mitral regurgitation (MR), and ventricular aneurysm. The coronary angiography results of all patients were comprehensively evaluated by two or more experienced interventional cardiovascular physicians. The appropriate intervention strategy was selected based on the angiography results, combined with the condition and willingness of patients. Coronary anatomic complexity was evaluated based on the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score, which was assessed by two experienced cardiologists. Complete revascularization is defined as successful revascularization of all coronary artery lesions or main segments ≥ 2mm in diameter with ≥ 70%. Stated revascularization was defined as a planned vessel revascularization within 30 days of the previous procedure. 2.3. Statistical analyses Data were analyzed using IBM SPSS for Windows, version 29.0 and R software (4.4.1). Continuous data with normal distributions are expressed as means ± SD. Non-normally distributed variables are presented as medians with interquartile ranges (IQRs) and were analyzed using the Mann–Whitney U test. Categorical variables are presented as numbers and percentages, and comparisons were performed using the chi-square test. Univariate and multivariable logistic regression analyses were performed to assess factors affecting LVEF improvement in patients with ICM. Nomogram prediction models for 6-month improvement in LVEF were developed respectively based on logistic regression. The discriminative ability of the model was evaluated using the area under curves (AUC) from the receiver operating characteristic (ROC) analysis. The calibration curves were generated using bootstrap methods to assess the consistency of the model. Decision curve analysis (DCA) was also employed to evaluate the clinical application value of this model. P-value < 0.05 was considered statistically significant. 3 Results A total of 337 ICM patients were hospitalized in our center from January 2019 to March 2024, including 195 patients underwent PCI, 68 patients underwent CABG, and 74 patients received drug treatment. Patients receiving CABG and drug therapy were excluded, as well as patients who were not underwent echocardiography at the 6-month follow-up. Finally, 123 patients were included. 3.1 Comparison of baseline data between the two groups Among the 123 patients enrolled in our study, 52 were in the improved LVEF group (≥ 10% improvement), whereas the remaining 71 were in the non-improved LVEF group (< 10% improvement or deterioration). The baseline characteristics are presented in Table 1 . We observed no statistical differences between the two groups regarding sex, age, body mass index, blood pressure, heart rate, smoking and drinking history, NYHA classification III or IV, prescribed medications, laboratory indicators, and coronary intervention parameters. However, In terms of medical conditions, fewer patients in the improved LVEF group had a prior myocardial infarction (MI) (32 [61.5%] vs. 56 [78.9%], P= 0.035). Table 1 Comparison of baseline data between the two groups Improved LVEF group ( n = 52) Non-improved LVEF group (n = 71) P Male[n(%)] 38 (73.1%) 51 (71.8%) 0.879 Age(x̅±SD, years) 62.9 ± 10.7 60.5 ± 9.7 0.199 Body mass index(Kg/m 2 ) 25.8 ± 3.7 25.8 ± 3.1 0.987 Systolic pressure(mmHg) 125.8 ± 13.7 123.3 ± 16.0 0.369 Diastolic pressure(mmHg) 78.3 ± 9.9 77.5 ± 10.3 0.672 Heart rate (x̅±SD) 76.2 ± 11.2 72.2 ± 13.6 0.078 Smoking [n(%)] 18 (34.6%) 34 (47.9%) 0.141 Drinking [n(%)] 10 (26.9%) 20 (28.2%) 0.879 Hypertension [n(%)] 34 (65.4%) 39 (54.9%) 0.244 Diabetes mellitus [n(%)] 19 (36.5%) 28 (39.4%) 0.744 Hyperlipidemia [n(%)] 13 (25.0%) 13 (18.3%) 0.369 Stroke [n(%)] 8 (15.4%) 14 (19.7%) 0.536 Prior MI [n(%)] 32 (61.5%) 56 (78.9%) 0.035 Prior PCI [n(%)] 15 (28.8%) 28 (39.4%) 0.224 NYHA classification III or IV 32 (61.5%) 42 (60.6%) 0.913 Aspirin [n(%)] 49 (94.2%) 64 (90.1%) 0.412 P2Y12 inhibitor [n(%)] 52 (100.0%) 71 (100.0%) 1.000 Statin [n(%)] 51 (98.1%) 71 (100.0%) 0.423 Beta-blocker [n(%)] 45 (86.5%) 67 (94.4%) 0.119 ARNI/ACEI/ARB [n(%)] 47 (90.4%) 61 (85.9%) 0.454 Loop diuretic agent [n(%)] 38 (73.1%) 47 (66.2%) 0.415 MRA [n(%)] 41 (78.8%) 56 (78.9%) 0.997 SGLT2i [n(%)] 24 (46.2%) 36 (50.7%) 0.618 Hb (x̅±SD, g/L) 136.4 ± 11.1 140.6 ± 11.8 0.050 ALB (x̅±SD, g/L) 41.8 ± 4.3 41.0 ± 3.8 0.275 Scr [ M ( P 25 , P 75 ), umol/L] 81.5 (68.0, 96.8) 80.0 (72.0, 89.0) 0.998 HDL-C [ M ( P 25 , P 75 ), mmol/L] 1.0 (0.9, 1.2) 1.0 (0.8, 1.1) 0.126 LDL-C [ M ( P 25 , P 75 ), mmol/L] 2.2 (1.9, 2.7) 2.2 (1.7, 2.7) 0.593 Lp(a) [ M ( P 25 , P 75 ), mg/dl] 15.7 (8.0, 44.1) 18.4 (6.6, 39.2) 0.728 HbA1c [ M ( P 25 , P 75 ), %] 6.3 (5.7, 7.4) 6.3 (5.8, 7.3) 0.766 Diseased coronary vessels LM [n(%)] 5 (9.6%) 8 (11.3%) 0.768 LAD [n(%)] 42 (80.8%) 54 (76.1%) 0.533 LCX [n(%)] 35 (67.3%) 45 (63.4%) 0.652 RCA [n(%)] 34 (65.4%) 49 (69.0%) 0.671 Two or Three Vessels disease [n(%)] 40 (76.9%) 50 (70.4%) 0.422 Complete revascularization [n(%)] 15 (28.8%) 26 (36.6%) 0.366 Total number of stents [ M ( P 25 , P 75 ), n] 2 (1, 2) 1 (1, 2) 0.220 Total stent length [ M ( P 25 , P 75 ), mm] 48.0 (30.8, 58.8) 37.0 (26.0, 55.0) 0.198 SYNTAX score [x̅±SD] 32.0 (22.1, 38.0) 24.0 (16.0, 36.5) 0.199 Data presented as mean ± SD, n (%), median (IQR). Abbreviations: MI, myocardial infarction; NYHA, New York Heart Association; ARNI, angiotensin receptor-neprilysin inhibitor; ACEI, angiotensin coverting enzyme inhibitors; ARB, angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium glucose co-transporter 2 inhibitors; Hb, hemoglobin; ALB, serum albumin; Scr, serum creatinine; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; Lp(a), serum lipoprotein(a); HbAlc, Hemoglobin A1C; LM, left main artery; LAD, left Anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; SYNTAX, Synergy between PCI with Taxus and Cardiac Surgery. 3.2 Comparison of echocardiographic results between the two groups 3.2.1 Echocardiographic results at admission The echocardiographic results, including admission baseline and 6 months follow-up data, are presented in Table 2 . There were no significant differences in LAD, IVS, LVEF, E/e’, and ventricular aneurysms between the groups. Patients in the improved LVEF group were significantly more likely to have a lower LVEDD (56.0 [52.0–59.0) vs. 59.0 [55.5–63.0], P= 0.002) and LVEDV (142.0 [117.3–168.5] vs. 176.0 [139.0–227.0], P= 0.003) than those in the non-improved LVEF group. Additionally, moderate or severe MR occurred in 21.2% of patients in the improved LVEF group, which was significantly lower than that in patients in the non-improved LVEF group (11 [21.2%] vs. 34 [47.9%], P= 0.002). 3.2.2 Echocardiographic results 6 months after discharge Compared with the non-improved LVEF group, LVEF in the improved LVEF group was significantly higher (59.0% [54.8–64.1%] vs. 41.9% [33.8–46.0%], P < 0.001). LVEDD (52.0 mm [47.0–57.8 mm] vs. 60.0 mm [53.0–64.0 mm], P<0.001) and LVEDV (135.5 mL [98.0–184.8 mL] vs. 199.0 mL [146.0–255.0] mL, P<0.001) were significantly lower in the improved LVEF group. The IVS was significantly lower in the non-improved LVEF group (9.0 mm [8.0–10.0 mm] vs. 9.0 mm [8.3–11.0 mm], P = 0.011). In this study, PCI reduced the proportion of ventricular aneurysms in patients with ICM; however, the reduction was more significant in the improved LVEF group (4 [7.7%] vs. 20 [28.2%], P= 0.005). Table 2 Comparison of echocardiographic results between the two groups Improved LVEF group ( n = 52) Non-improved LVEF group (n = 71) P Initial echocardiography LVEF [ M ( P 25 , P 75 ), %] 41.9 (35.2, 45.7) 40.8 (35.4, 46.0) 0.978 LAD [ M ( P 25 , P 75 ), mm] 39.0 (36.0, 43.0) 40.0 (36.0, 44.0) 0.434 LVEDD [ M ( P 25 , P 75 ), mm] 56.0 (52.0, 59.0) 59.0 (56.0, 63.0) 0.002 IVS [M(P25, P75), mm] 9.0 (9.0, 10.0) 10.0 (8.0, 10.0) 0.584 LVEDV [M(P25, P75), ml] 142.0 (117.3, 168.5) 176.0 (139.0, 227.0) 0.003 E/e’ [ M ( P 25 , P 75 )] 14.7 (11.9, 18.2) 14.0 (10.8, 19) 0.532 Moderate or severe MR [n(%)] 11 (21.2%) 34 (47.9%) 0.002 ventricular aneurysm [n(%)] 6 (11.5%) 11 (15.5%) 0.530 six months after discharge echocardiography EF [ M ( P 25 , P 75 ), %] 59.3 (54.8, 64.1) 41.9 (33.8, 46.0) <0.001 LAD [ M ( P 25 , P 75 ), mm] 37.0 (34.0, 40.0) 38.0 (35.0, 43.0) 0.082 LVEDD [ M ( P 25 , P 75 ), mm] 52.0 (47.0, 57.8) 60.0 (53.0, 64.0) <0.001 IVS [ M ( P 25 , P 75 ), mm] 9.0 (8.3, 11.0) 9.0 (8.0, 9.0) 0.011 LVEDV [ M ( P 25 , P 75 ), ml] 135.5 (98.0, 184.8) 199.0 (146.0, 255.0) <0.001 E/e’ [ M ( P 25 , P 75 )] 14.0 (10.8, 16.7) 13.5 (10.0, 18.0) 0.658 Moderate or severe MR [n(%)] 8 (15.4%) 17 (23.9%) 0.244 ventricular aneurysm [n(%)] 4 (7.7%) 20 (28.2%) 0.005 Data presented as mean ± SD, n (%), median (IQR). Abbreviations: LVEF, left ventricular ejection fraction; LAD, Left atrial diameter;LVEDD, left ventricular end-diastolic dimension; LVEDV, left ventricular end-diastolic volume; IVS, inter-ventricular septal; E/e’, early diastolic transmitral velocity to early diastolic mitral annular velocity; MR, mitral regurgitation. 3.3 Development and evaluation of a nomogram prediction model for 6-month improvement in LVEF in patients with ICM after PCI A univariate logistic regression analysis was conducted to examine the associations between baseline clinical characteristics, echocardiographic parameters, peripheral blood markers, and changes in ejection fraction at six months after PCI. Prior MI, LVEDD, LVEDV, and moderate or severe MR were identified as risk factors for non-improvement in LVEF (Table 3) . In order to better utilize these indicators and further verify their clinical application value, we incorporated the abovementioned four risk factors and constructed a nomogram predictive model for 6-month improvement in LVEF based on logistic regression (Figure.1A) . ROC curve was plotted to evaluate the model's discriminative ability, with an area under the curve of 0.734(95% CI: 0.6438–0.8237) (Figure.1B) . The calibration curve demonstrates a great concordance between predictions and the actual observations (Figure.1C) . Decision curve analysis reveals that when the threshold probability varies between 15% and 55%, the application of the model provides greater benefits (Figure.1D) . Furthermore, in the subsequent multivariable logistic regression analysis, prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM (Table.3) . Table 3 Determinants of LVEF Improvement: Univariate and Multivariate Logistic Regression Analysis Determinant variable: LVEF improvement (delta LVEF ≥ 10%) Univariate Logistic Regression Analysis Multivariate Logistic Regression Analysis Independent variable OR 95%CI P OR 95%CI P Prior MI 2.333 1.051-5.183 0.037 2.435 1.015-5.840 0.046 LVEDD 1.089 1.026-1.156 0.005 1.017 0.927-1.116 0.720 LVEDV 1.010 1.003-1.018 0.004 1.007 0.996-1.018 0.215 Moderate or severe MR 3.425 1.520-7.716 0.003 2.751 1.148-6.588 0.023 Abbreviations: MI, myocardial infarction; LVEDD, left ventricular end-diastolic dimension; LVEDV, left ventricular end-diastolic volume; MR, mitral regurgitation. 4 Discussion In this retrospective analysis, we evaluated LVEF in 123 patients with ICM using echocardiography 6 months after PCI. Among them, 52 patients (42.3%) showed improvement in LVEF. We show that Prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. In addition, prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM. The improvement of left ventricular function is crucial for predicting the prognosis of patients with ischemic left ventricular dysfunction undergoing revascularization. This improvement is primarily reflected in the absolute increase of LVEF. Previous studies 10-11,17-21 have shown that an increase of ≥10% in LVEF compared with baseline LVEF can significantly reduce the incidence of cardiac events and all-cause mortality in patients with heart failure. Therefore, this study also defined the improved LVEF group as those with a ≥10% increase in LVEF on echocardiographic results at the 6-month follow-up after discharge compared with that at baseline. A real-world study conducted in China 18 found that 45.7% of patients with ICM experienced a ≥10% improvement in LVEF, as assessed by echocardiography at least 90 days after revascularization. In another study by Adachi et al. 19 , 42.6% of patients with ICM showed an improvement of ≥10% in LVEF after receiving optimal drug treatment combined with revascularization. This retrospective study analyzed the improvement of LVEF in patients with ICM after PCI at 6 months, and the results showed that 42.3% of patients had a ≥10% LVEF improvement. These results were higher than the 16% improvement observed in the STICH substudy 11 . The baseline LVEF of the patients included in the STICH study was ≤35%, which was significantly lower than that of the abovementioned studies. Additionally, the time of echocardiography review was 24 months after revascularization, which was significantly longer than that of the abovementioned studies, and the worsening of cardiac function after improvement in some patients could not be excluded. MI can cause ventricular remodeling, characterized by changes in the heart’s structure and function, including increased volume, thinning of the ventricular wall, and decreased LVEF 22-24 . LVEF and LVEDV are important diagnostic indices of ventricular remodeling 25,26 . Inappropriate ventricular remodeling reduces myocardial contractility, increases the risk of heart failure, and affects survival 27 . Reverse ventricular remodeling refers to the return of the ventricle’s size and shape to normal 28 , which is associated with improvements in myocardial contractility and left ventricular systolic function 29 ,30 , and is linearly correlated with improved survival 31 . Our study found that a history of MI was an independent risk factor for LVEF improvement after revascularization in patients with ICM, and the changes in left ventricular shape caused by ischemia, such as LVEDV and LVEDD, were factors influencing LVEF improvement. During the later follow-up, patients in the non-improved LVEF group experienced further enlargement of left ventricular dimension and volume, thinning of the left ventricular wall, and increased proportion of ventricular aneurysms; these indicate that inappropriate ventricular remodeling is not advantageous for the recovery of left ventricular function in patients. Functional MR caused by ventricular remodeling is a serious consequence of CAD and increases the incidence of heart failure and cardiovascular mortality 32,33 . The severity of MR affects the efficacy of revascularization, with moderate-to-severe MR being an independent predictor of short- and long-term adverse prognosis in patients with CAD after PCI 34 . The STICH study showed that the mortality of patients with moderate and severe MR was significantly increased, and CABG combined with MR repair provided more significant benefits compared with CABG alone 35 . However, another study showed that in patients with moderate ischemic MR undergoing CABG, the addition of mitral-valve repair did not lead to significant differences in left ventricular reverse remodeling, did not significantly improve survival or reduce overall adverse events and readmissions, and was associated with an early risk of increased neurologic and supraventricular arrhythmias 36 . This study found that 36.6% of patients with ICM had moderate or severe ischemic MR, which was an independent risk factor affecting LVEF improvement in patients with ICM after PCI. Six months after discharge, the follow-up echocardiographic results showed that, regardless of LVEF improvement, 44.4% of patients with moderate or severe MR experienced a significant reduction in MR severity, suggesting that PCI can improve adverse ventricular remodeling in some patients with ICM. This study had some limitations. First, it was a single-center retrospective study, which inherently introduces selection bias and date absence. Second, the study group was relatively small. Third, this study only included patients who had echocardiographic results at 6 months after discharge. Compared with all patients with ICM who received PCI, the high rate of loss to follow-up may have impacted the results. Fourth, we did not follow on long-term events; thus, it was not possible to determine the association between improved ejection fraction and the occurrence of adverse events. Conclusions Prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. Prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM. The adverse ventricular remodeling caused by ischemic factors negatively affected the improvement of cardiac function in patients with ICM. Standard drug therapy combined with PCI can reverse adverse ventricular remodeling in some patients and improve their cardiac function. However, the relationship between LVEF improvement after PCI in patients with ICM and clinical outcomes needs to be further confirmed by larger clinical studies. Declarations Ethics approval and consent to participate: This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University(2024-R218). Consent for publication: All the participants signed the written informed consent. Data availability: The data that support the findings of this study are available from the Second Hospital of Hebei Medical University, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Second Hospital of Hebei Medical University. Competing interests: The authors declare no competing interests. Funding: This research was supported by Clinical Medical Talents Training Project Funded by Hebei Provincial Government, China [ZF2023152]. Authors' contributions: L.S., X.F., Y.W. and X.G. contributed to the conception and design of the work; L.S. drafted the manuscript; L.S., Y.J., Q.W., W.Z., Y.L. and Z.G. contributed to the acquisition, analysis, and interpretation of data; L.S., Y.W., Y.F., and X.G. critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Acknowledgements: Not applicable. Clinical trial number: not applicable. References Felker GM, Shaw LK, O’Connor CM. A Standardized Definition of Ischemic Cardiomyopathy for Use in Clinical Research. J Am Coll Cardiol. 2002; 39: 210-218. Cabac-Pogorevici I, Muk B, Rustamova Y, Kalogeropoulos A, Tzeis S, Vardas P. Ischaemic cardiomyopathy. Pathophysiological insights, diagnostic management and the roles of revascularisation and device treatment. Gaps and dilemmas in the era of advanced technology. Eur J Heart Fail. 2020; 22: 789–799. 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Change in ejection fraction and long-term mortality in adults referred for echocardiography. EUR J HEART FAIL. 2021; 23: 555-563. Velagaleti RS, Vetter J, Parker R, Kurgansky KE, Sun YV, Djousse L, et al. Change in Left Ventricular Ejection Fraction with Coronary Artery Revascularization and Subsequent Risk for Adverse Cardiovascular Outcomes. CIRC-CARDIOVASC INTE. 2022; 15: e011284. Joshi K, Alam I, Ruden E, Gradus-Pizlo I, Mahenthiran J, Kamalesh M, et al. Effect of improvement in left ventricular ejection fraction on long-term survival in revascularized patients with ischaemic left ventricular systolic dysfunction. EUR J ECHOCARDIOGR. 2011; 12: 454-460. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015; 36: 2793–2867. Li Q, Qiao Y, Tang J, Guo YL, Liu K, Yang BG, et al. Frequency, predictors, and prognosis of heart failure with improved left ventricular ejection fraction: a single-centre retrospective observational cohort study. ESC Heart Fail. 2021; 8: 2755-2764. Peng D, Liu JH. Improvement of LVEF in patients with HFrEF with coronary heart disease after revascularization—A real-world study. J INTERV CARDIOL. 2018; 31: 731-736. Adachi Y, Sakakura K, Wada H, Funayama H, Umemoto T, Fujita H, et al. Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF). INT HEART J. 2016; 57: 565-572. Wilcox JE, Fonarow GC, Yancy C W, Albert NM, Curtis AB, Heywood JT, et al. Factors associated with improvement in ejection fraction in clinical practice among patients with heart failure: findings from IMPROVE HF. AM HEART J. 2012; 163: 49-56.e2. DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J, Patterson JH, et al. The association of improvement in left ventricular ejection fraction with outcomes in patients with heart failure with reduced ejection fraction: data from CHAMP-HF. EUR J HEART FAIL. 2022; 24: 762-770. Frantz S, Hundertmark MJ, Schulz-Menger J, Bengel FM, Bauersachs J, et al. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. EUR HEART J. 2022; 43: 2549-2561. Ohtani Tomohito, Mohammed SF, Yamamoto K, Dunlay SM, Weston SA, Sakata Y, et al. Diastolic stiffness as assessed by diastolic wall strain is associated with adverse remodelling and poor outcomes in heart failure with preserved ejection fraction. EUR HEART J. 2012; 33: 1742-1749. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J AM COLL CARDIOL. 2000; 35: 569-82. Cokkinos DV, Belogianneas C. Left Ventricular Remodelling: A Problem in Search of Solutions. EUR CARDIOL REV. 2016; 11: 29-35. Echouffo-Tcheugui JB, Erqou S, Butler J, Yancy CW, Fonarow GC. Assessing the Risk of Progression From Asymptomatic Left Ventricular Dysfunction to Overt Heart Failure: A Systematic Overview and Meta-Analysis. JACC-HEART FAIL. 2016; 4: 237-248. Bolognese L, Neskovic AN, Parodi G, Cerisano G, Buonamici P, Santoro GM, et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002; 106: 2351–2357. Wilcox JE, Fang JC, Margulies KB, Mann DL. Heart Failure With Recovered Left Ventricular Ejection Fraction: JACC Scientific Expert Panel. J AM COLL CARDIOL. 2020; 76: 719-734. Dipla K, Mattiello JA, Jeevanandam V, Houser SR, Margulies KB. Myocyte recovery after mechanical circulatory support in humans with end-stage heart failure. CIRCULATION. 1998; 97: 2316-2322. Topkara VK, Chambers KT, Yang KC, Tzeng HP, Evans S, Weinheimer C, et al. Functional significance of the discordance between transcriptional profile and left ventricular structure/function during reverse remodeling. JCI Insight. 2016; 1: e86038. Kramer DG, Trikalinos TA, Kent DM, Antonopoulos GV, Konstam MA, Udelson JE. Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach. J AM COLL CARDIOL. 2010; 56: 392-406. Szymanski C, Levine RA, Tribouilloy C, Zheng H, Handschumacher MD, Tawakol A, et al. Impact of mitral regurgitation on exercise capacity and clinical outcomes in patients with ischemic left ventricular dysfunction. AM J CARDIOL. 2011; 108: 1714-1720. .Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation. 2003; 108: 1713-1717. Pastorius CA, Henry TD, Harris KM. Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention. AM J CARDIOL. 2007; 100: 1218-1223. Deja MA, Grayburn PA, Sun B, Rao V, She L, Krejca M, et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation. 2012; 125: 2639–2648. Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. NEW ENGL J MED. 2016; 374: 1932-1941. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5167990","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":363291396,"identity":"7b4619fb-9ffc-4f16-9a5a-d6b7d1f8db37","order_by":0,"name":"Lifang Su","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lifang","middleName":"","lastName":"Su","suffix":""},{"id":363291397,"identity":"60fb52c8-f071-4691-9a29-95750f242bba","order_by":1,"name":"Xianghua Fu","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xianghua","middleName":"","lastName":"Fu","suffix":""},{"id":363291398,"identity":"2132a226-3ca5-4b6f-8c38-322f9192111a","order_by":2,"name":"Yanbo Wang","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanbo","middleName":"","lastName":"Wang","suffix":""},{"id":363291399,"identity":"093b605f-4c0b-4853-a10c-4a0cded28214","order_by":3,"name":"Yunfa Jiang","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yunfa","middleName":"","lastName":"Jiang","suffix":""},{"id":363291400,"identity":"3572706c-4cf9-4f53-924d-72496c42c5f6","order_by":4,"name":"Yang Fu","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Fu","suffix":""},{"id":363291401,"identity":"0109d960-022e-407e-bf21-ae4b41ea60fa","order_by":5,"name":"Qing Wang","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Wang","suffix":""},{"id":363291402,"identity":"5617321c-a646-4940-afe7-bf6f9998bfb5","order_by":6,"name":"Wei Zhi","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhi","suffix":""},{"id":363291403,"identity":"b03f9442-d503-478f-9317-1270ee7e6bd0","order_by":7,"name":"Yi Li","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Li","suffix":""},{"id":363291404,"identity":"f335aa81-9f5e-4928-940e-113b5a18bcbf","order_by":8,"name":"Zhengkun Guan","email":"","orcid":"","institution":"The Fourth Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhengkun","middleName":"","lastName":"Guan","suffix":""},{"id":363291405,"identity":"5fe2bec9-77c8-4489-93c6-b7466c195d1d","order_by":9,"name":"Xinshun Gu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACfvbmAwcSfkjI8UswsEGEDhDQItlzLPHBxx4bY8kZxGoxuOGjbDiDLS1xww1itTDc4GGT5uE5zLj5dvOxRzfbGOT4biQwfi7Ao4Nxdu8xaR6Lw8xmd46lG+e2MRhL3khglp6BRwuzzLk0kC1sZjdyzKSBWoAuTGBj5sGjhU0CqJKH7TCP8Yz8byAt9QS18EjkGIO8L2EgkcMG0pJgQEiLBA8kkA0kbqSZG+eckzCceeZhszQ+LfbHIVFZ3z8j+dnjnDIbeb7jyQc/49OCYSsQMzaQoGEUjIJRMApGATYAANMQTmlXgqphAAAAAElFTkSuQmCC","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xinshun","middleName":"","lastName":"Gu","suffix":""}],"badges":[],"createdAt":"2024-09-28 02:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5167990/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5167990/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71682775,"identity":"a8f9f7fc-c3af-4bbb-8af9-82a1aa70dfca","added_by":"auto","created_at":"2024-12-17 16:50:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86306,"visible":true,"origin":"","legend":"\u003cp\u003eThe development and evaluation of a nomogram prediction model in patients with ICM after PCI: Nomogram for 6-month improvement of LVEF (A). ROC curve of the nomogram model (B), calibration curve for nomogram by bootstrap with 1000 repetitions (C), and decision curve analysis of the nomogram (D).\u003c/p\u003e\n\u003cp\u003eAbbreviations: MI, myocardial infarction; LVEDD, left ventricular end-diastolic dimension; LVEDV, left ventricular end-diastolic volume; MR, mitral regurgitation.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5167990/v1/b9deb13e8deb9e0437aa2249.png"},{"id":104499356,"identity":"8e04e313-036e-4d62-bf5d-72eda1763eca","added_by":"auto","created_at":"2026-03-12 13:26:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022318,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5167990/v1/60bc314e-69d0-4f9f-944a-4875d76aba46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of risk factors and development of prediction model for improvement of ejection fraction in patients with ischemic cardiomyopathy after percutaneous coronary intervention: a case control study","fulltext":[{"header":"1 Background","content":"\u003cp\u003eIschemic cardiomyopathy (ICM) is a disease characterized by myocardial degeneration, necrosis, and fibrosis caused by coronary artery disease (CAD), particularly lesions in the left main artery or multiple coronary arteries, leading to severe left ventricular systolic dysfunction\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. This dysfunction represents the final stage of CAD and the main cause of heart failure with reduced ejection fraction (HFrEF)\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. For patients with ICM, revascularization, primarily involving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), should be considered based on optimal drug treatment\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. However, revascularization therapy is not suitable for all patients\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Therefore, an effective method is needed to predict the benefits of revascularization before treatment.\u003c/p\u003e \u003cp\u003eRegardless of the cause of HFrEF, improving left ventricular function is the key treatment objective, and left ventricular ejection fraction (LVEF) is an important prognostic factor for patients with HFrEF. Compared with those with sustained reduction in LVEF, patients with improved LVEF experience significantly improved quality of life and reduced incidence of short and long-term adverse cardiovascular events\u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. A long-term follow-up study of patients after PCI (mean/maximum, 5/14 years) showed that a 5% increase in LVEF was associated with a 6% reduction in mortality and a 10% reduction in hospital length of stay for heart failure\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. LVEF is also a significant predictor of the long-term prognosis of patients with ICM having revascularization\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, and guidelines recommend that echocardiography be repeated at least 90 days after revascularization to assess treatment effects and predict outcomes in patients with ICM\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. However, despite receiving standard drug therapy and revascularization, the proportion of LVEF improvement remains low in patients with ischemic HFrEF\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Currently, the underlying mechanisms and factors influencing LVEF improvement in patients with HFrEF remain unclear, and there is a lack of relevant studies investigating LVEF improvement in patients with ICM following PCI, particularly the lack of a clinically applicable prognostic model. Therefore, this study aimed to investigate the factors influencing LVEF improvement in patients with ICM after PCI, and based on the key factors, establish a prognostic model to help clinicians better distinguish patients with poor prognosis.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and patient population\u003c/h2\u003e \u003cp\u003eThis single-center retrospective study included consecutive patients with ICM who underwent PCI at the Second Hospital of Hebei Medical University between January 2019 to March 2024. This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) over 18 years old; (2) patients with coronary angiography showing\u0026thinsp;\u0026ge;\u0026thinsp;70% stenosis in the main coronary artery and its major branches, with or without stenosis of the left main artery\u0026thinsp;\u0026ge;\u0026thinsp;50% who underwent PCI during hospitalization; (3) echocardiography indicating regional wall motion abnormalities with LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50% at admission; (4) participants were required to undergo echocardiography at the 6-month follow-up.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: (1) patients with primary myocardiopathy, congenital heart disease, rheumatic heart disease, or other nonischemic myocardial diseases; (2) patients with chronic obstructive pulmonary disease, primary pulmonary hypertension, or other diseases affecting cardiac function; (3) patients who had experienced acute myocardial infarction within 1 month; had a history of CABG; or had received a pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy; (4) patients with acute myocardial infarction, unplanned revascularization, heart valve intervention, heart transplantation, and self-withdrawal of pharmacological treatment within 6 months after discharge.\u003c/p\u003e \u003cp\u003eBased on the change in LVEF ([LVEF follow-up] \u0026ndash; [LVEF admission]), patients were categorized into two groups: the improved LVEF group, including patients with a\u0026thinsp;\u0026ge;\u0026thinsp;10% improvement, and the non-improved LVEF group, including patients with \u0026lt;\u0026thinsp;10% improvement or deterioration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003eBaseline clinical characteristics of the patients, including demographic data, medical conditions, prescribed medications, laboratory data, echocardiography parameters at admission and 6 months after discharge, and coronary interventional parameters, were collected.\u003c/p\u003e \u003cp\u003eEchocardiography was performed independently by two experienced technicians using two-dimensional, targeted M-mode echocardiographs, and Doppler ultrasound measurements were obtained using standard techniques based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Echocardiography parameters assessed included left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV), inter-ventricular septal (IVS), LVEF, early diastolic transmitral velocity to early diastolic mitral annular velocity (E/e\u0026rsquo;), degree of mitral regurgitation (MR), and ventricular aneurysm.\u003c/p\u003e \u003cp\u003eThe coronary angiography results of all patients were comprehensively evaluated by two or more experienced interventional cardiovascular physicians. The appropriate intervention strategy was selected based on the angiography results, combined with the condition and willingness of patients. Coronary anatomic complexity was evaluated based on the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score, which was assessed by two experienced cardiologists. Complete revascularization is defined as successful revascularization of all coronary artery lesions or main segments\u0026thinsp;\u0026ge;\u0026thinsp;2mm in diameter with \u0026ge;\u0026thinsp;70%. Stated revascularization was defined as a planned vessel revascularization within 30 days of the previous procedure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Statistical analyses\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS for Windows, version 29.0 and R software (4.4.1). Continuous data with normal distributions are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Non-normally distributed variables are presented as medians with interquartile ranges (IQRs) and were analyzed using the Mann\u0026ndash;Whitney U test. Categorical variables are presented as numbers and percentages, and comparisons were performed using the chi-square test. Univariate and multivariable logistic regression analyses were performed to assess factors affecting LVEF improvement in patients with ICM. Nomogram prediction models for 6-month improvement in LVEF were developed respectively based on logistic regression. The discriminative ability of the model was evaluated using the area under curves (AUC) from the receiver operating characteristic (ROC) analysis. The calibration curves were generated using bootstrap methods to assess the consistency of the model. Decision curve analysis (DCA) was also employed to evaluate the clinical application value of this model. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eA total of 337 ICM patients were hospitalized in our center from January 2019 to March 2024, including 195 patients underwent PCI, 68 patients underwent CABG, and 74 patients received drug treatment. Patients receiving CABG and drug therapy were excluded, as well as patients who were not underwent echocardiography at the 6-month follow-up. Finally, 123 patients were included.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Comparison of baseline data between the two groups\u003c/h2\u003e\n \u003cp\u003eAmong the 123 patients enrolled in our study, 52 were in the improved LVEF group (\u0026ge;\u0026thinsp;10% improvement), whereas the remaining 71 were in the non-improved LVEF group (\u0026lt;\u0026thinsp;10% improvement or deterioration). The baseline characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. We observed no statistical differences between the two groups regarding sex, age, body mass index, blood pressure, heart rate, smoking and drinking history, NYHA classification III or IV, prescribed medications, laboratory indicators, and coronary intervention parameters. However, In terms of medical conditions, fewer patients in the improved LVEF group had a prior myocardial infarction (MI) (32 [61.5%] vs. 56 [78.9%], P= 0.035).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of baseline data between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eImproved LVEF group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-improved LVEF\u003c/p\u003e\n \u003cp\u003egroup (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (73.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (71.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.879\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(x̅\u0026plusmn;SD, years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBody mass index(Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic pressure(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic pressure(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeart rate (x̅\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrinking [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.879\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (65.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (39.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperlipidemia [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStroke [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (19.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrior MI [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (78.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrior PCI [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (39.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNYHA classification III or IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAspirin [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (94.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (90.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP2Y12 inhibitor [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatin [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (98.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBeta-blocker [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eARNI/ACEI/ARB [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (85.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLoop diuretic agent [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (73.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (66.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMRA [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (78.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (78.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSGLT2i [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHb (x̅\u0026plusmn;SD, g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALB (x̅\u0026plusmn;SD, g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScr [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), umol/L]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.5 (68.0, 96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.0 (72.0, 89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL-C [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mmol/L]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.9, 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (0.8, 1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL-C [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mmol/L]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2 (1.9, 2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2 (1.7, 2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLp(a) [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mg/dl]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7 (8.0, 44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.4 (6.6, 39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHbA1c [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), %]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3 (5.7, 7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3 (5.8, 7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiseased coronary vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLM [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAD [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (80.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLCX [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (67.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (63.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCA [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (65.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwo or Three Vessels disease [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (70.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplete revascularization [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal number of stents [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), n]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1, 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1, 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal stent length [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.0 (30.8, 58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.0 (26.0, 55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSYNTAX score [x̅\u0026plusmn;SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.0 (22.1, 38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.0 (16.0, 36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, n (%), median (IQR). Abbreviations: MI, myocardial infarction; NYHA, New York Heart Association; ARNI, angiotensin receptor-neprilysin inhibitor; ACEI, angiotensin coverting enzyme inhibitors; ARB, angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium glucose co-transporter 2 inhibitors; Hb, hemoglobin; ALB, serum albumin; Scr, serum creatinine; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; Lp(a), serum lipoprotein(a); HbAlc, Hemoglobin A1C; LM, left main artery; LAD, left Anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; SYNTAX, Synergy between PCI with Taxus and Cardiac Surgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Comparison of echocardiographic results between the two groups\u003c/h2\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.1 Echocardiographic results at admission\u003c/h2\u003e\n \u003cp\u003eThe echocardiographic results, including admission baseline and 6 months follow-up data, are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. There were no significant differences in LAD, IVS, LVEF, E/e\u0026rsquo;, and ventricular aneurysms between the groups. Patients in the improved LVEF group were significantly more likely to have a lower LVEDD (56.0 [52.0\u0026ndash;59.0) vs. 59.0 [55.5\u0026ndash;63.0], P= 0.002) and LVEDV (142.0 [117.3\u0026ndash;168.5] vs. 176.0 [139.0\u0026ndash;227.0], P= 0.003) than those in the non-improved LVEF group. Additionally, moderate or severe MR occurred in 21.2% of patients in the improved LVEF group, which was significantly lower than that in patients in the non-improved LVEF group (11 [21.2%] vs. 34 [47.9%], P= 0.002).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.2 Echocardiographic results 6 months after discharge\u003c/h2\u003e\n \u003cp\u003eCompared with the non-improved LVEF group, LVEF in the improved LVEF group was significantly higher (59.0% [54.8\u0026ndash;64.1%] vs. 41.9% [33.8\u0026ndash;46.0%], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). LVEDD (52.0 mm [47.0\u0026ndash;57.8 mm] vs. 60.0 mm [53.0\u0026ndash;64.0 mm], P\u0026lt;0.001) and LVEDV (135.5 mL [98.0\u0026ndash;184.8 mL] vs. 199.0 mL [146.0\u0026ndash;255.0] mL, P\u0026lt;0.001) were significantly lower in the improved LVEF group. The IVS was significantly lower in the non-improved LVEF group (9.0 mm [8.0\u0026ndash;10.0 mm] vs. 9.0 mm [8.3\u0026ndash;11.0 mm], P\u0026thinsp;=\u0026thinsp;0.011). In this study, PCI reduced the proportion of ventricular aneurysms in patients with ICM; however, the reduction was more significant in the improved LVEF group (4 [7.7%] vs. 20 [28.2%], P= 0.005).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of echocardiographic results between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eImproved LVEF group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-improved LVEF group (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInitial echocardiography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEF [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), %]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.9 (35.2, 45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.8 (35.4, 46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAD [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.0 (36.0, 43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.0 (36.0, 44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEDD [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.0 (52.0, 59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.0 (56.0, 63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIVS [M(P25, P75), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.0 (9.0, 10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.0 (8.0, 10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEDV [M(P25, P75), ml]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e142.0 (117.3, 168.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176.0 (139.0, 227.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eE/e\u0026rsquo; [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.7 (11.9, 18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.0 (10.8, 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate or severe MR [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eventricular aneurysm [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esix months after discharge echocardiography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEF [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), %]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.3 (54.8, 64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.9 (33.8, 46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAD [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.0 (34.0, 40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.0 (35.0, 43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEDD [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.0 (47.0, 57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.0 (53.0, 64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIVS [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), mm]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.0 (8.3, 11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.0 (8.0, 9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEDV [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e), ml]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135.5 (98.0, 184.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e199.0 (146.0, 255.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eE/e\u0026rsquo; [\u003cem\u003eM\u003c/em\u003e(\u003cem\u003eP\u003c/em\u003e\u003csub\u003e25\u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e75\u003c/sub\u003e)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.0 (10.8, 16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5 (10.0, 18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate or severe MR [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eventricular aneurysm [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, n (%), median (IQR). Abbreviations: LVEF, left ventricular ejection fraction; LAD, Left atrial diameter;LVEDD, left ventricular end-diastolic dimension; LVEDV, left ventricular end-diastolic volume; IVS, inter-ventricular septal; E/e\u0026rsquo;, early diastolic transmitral velocity to early diastolic mitral annular velocity; MR, mitral regurgitation.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e3.3 Development and evaluation of a nomogram prediction model for 6-month improvement in LVEF in patients with ICM after PCI\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eA univariate logistic regression analysis was conducted to examine the associations between baseline clinical characteristics, echocardiographic parameters, peripheral blood markers, and changes in ejection fraction at six months after PCI. Prior MI, LVEDD, LVEDV, and moderate or severe MR were identified as risk factors for non-improvement in LVEF \u003cem\u003e(Table\u0026nbsp;3)\u003c/em\u003e. In order to better utilize these indicators and further verify their clinical application value, we incorporated the abovementioned four risk factors and constructed a \u003cem\u003enomogram\u003c/em\u003e predictive model for 6-month improvement in \u003cem\u003eLVEF\u003c/em\u003e based on logistic regression \u003cem\u003e(Figure.1A)\u003c/em\u003e. ROC curve was plotted to evaluate the model\u0026apos;s discriminative ability, with an area under the curve of 0.734(95% CI: 0.6438\u0026ndash;0.8237) \u003cem\u003e(Figure.1B)\u003c/em\u003e. The calibration curve demonstrates a great concordance between predictions and the actual observations \u003cem\u003e(Figure.1C)\u003c/em\u003e. Decision curve analysis reveals that when the threshold probability varies between 15% and 55%, the application of the model provides greater benefits \u003cem\u003e(Figure.1D)\u003c/em\u003e. Furthermore, in the subsequent multivariable logistic regression analysis, prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM \u003cem\u003e(Table.3)\u003c/em\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;3\u003c/strong\u003e Determinants of LVEF Improvement: Univariate and Multivariate Logistic Regression Analysis\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 503px;\"\u003e\n \u003cp\u003eDeterminant variable: LVEF improvement (delta LVEF\u0026nbsp;\u0026ge;\u0026nbsp;10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 249px;\"\u003e\n \u003cp\u003eUnivariate Logistic Regression Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 254px;\"\u003e\n \u003cp\u003eMultivariate Logistic Regression Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eIndependent variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003ePrior MI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.051-5.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e1.015-5.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eLVEDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.026-1.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.927-1.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eLVEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.003-1.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.996-1.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eModerate or severe MR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.520-7.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e1.148-6.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eAbbreviations: MI, myocardial infarction; LVEDD, left ventricular end-diastolic dimension; LVEDV, left ventricular end-diastolic volume; MR, mitral regurgitation.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn this retrospective analysis, we evaluated LVEF in 123 patients with ICM using echocardiography 6 months after PCI. Among them, 52 patients (42.3%) showed improvement in LVEF. We show that Prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. In addition, prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe improvement of left ventricular function is crucial for predicting the prognosis of patients with ischemic left ventricular dysfunction undergoing revascularization. This improvement is primarily reflected in the absolute increase of LVEF. Previous studies\u003csup\u003e10-11,17-21\u003c/sup\u003e have shown that an increase of ≥10% in LVEF compared with baseline LVEF can significantly reduce the incidence of cardiac events and all-cause mortality in patients with heart failure. Therefore, this study also defined the improved LVEF group as those with a ≥10% increase in LVEF on echocardiographic results at the 6-month follow-up after discharge compared with that at baseline.\u003c/p\u003e\n\u003cp\u003eA real-world study conducted in China\u003csup\u003e18\u003c/sup\u003e found that 45.7% of patients with ICM experienced a ≥10% improvement in LVEF, as assessed by echocardiography at least 90 days after revascularization. In another study by Adachi et al.\u003csup\u003e19\u003c/sup\u003e, 42.6% of patients with ICM showed an improvement of ≥10% in LVEF after receiving optimal drug treatment combined with revascularization. This retrospective study analyzed the improvement of LVEF in patients with ICM after PCI at 6 months, and the results showed that 42.3% of patients had a ≥10% LVEF improvement. These results were higher than the 16% improvement observed in the STICH substudy\u003csup\u003e11\u003c/sup\u003e. The baseline LVEF of the patients included in the STICH study was ≤35%, which was significantly lower than that of the abovementioned studies. Additionally, the time of echocardiography review was 24 months after revascularization, which was significantly longer than that of the abovementioned studies, and the worsening of cardiac function after improvement in some patients could not be excluded.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MI can cause ventricular remodeling, characterized by changes in the heart’s structure and function, including increased volume, thinning of the ventricular wall, and decreased LVEF\u003csup\u003e22-24\u003c/sup\u003e. LVEF and LVEDV are important diagnostic indices of ventricular remodeling\u003csup\u003e25,26\u003c/sup\u003e. Inappropriate ventricular remodeling reduces myocardial contractility, increases the risk of heart failure, and affects survival\u003csup\u003e27\u003c/sup\u003e. Reverse ventricular remodeling refers to the return of the ventricle’s size and shape to normal\u003csup\u003e28\u003c/sup\u003e, which is associated with improvements in myocardial contractility and left ventricular systolic function\u003csup\u003e29\u003c/sup\u003e\u003csup\u003e,30\u003c/sup\u003e, and is linearly correlated with improved survival\u003csup\u003e31\u003c/sup\u003e. Our study found that a history of MI was an independent risk factor for LVEF improvement after revascularization in patients with ICM, and the changes in left ventricular shape caused by ischemia, such as LVEDV and LVEDD, were\u0026nbsp;factors influencing\u0026nbsp;LVEF improvement. During the later follow-up, patients in the non-improved LVEF group experienced further enlargement of left ventricular dimension and volume, thinning of the left ventricular wall, and increased proportion of ventricular aneurysms; these indicate that inappropriate ventricular remodeling is not advantageous\u0026nbsp;for the recovery of left ventricular function in patients.\u003c/p\u003e\n\u003cp\u003eFunctional MR caused by ventricular remodeling is a serious consequence of CAD and increases the incidence of heart failure and cardiovascular mortality\u003csup\u003e32,33\u003c/sup\u003e. The severity of MR affects the efficacy of revascularization, with moderate-to-severe MR being an independent predictor of short- and long-term adverse prognosis in patients with CAD after PCI\u003csup\u003e34\u003c/sup\u003e. The STICH study showed that the mortality of patients with moderate and severe MR was significantly increased, and CABG combined with MR repair provided more significant benefits compared with CABG alone\u003csup\u003e35\u003c/sup\u003e. However, another study showed that in patients with moderate ischemic MR undergoing CABG, the addition of mitral-valve repair did not lead to significant differences in left ventricular reverse remodeling, did not significantly improve survival or reduce overall adverse events and readmissions, and was associated with an early risk of increased neurologic and supraventricular arrhythmias\u003csup\u003e36\u003c/sup\u003e. This study found that 36.6% of patients with ICM had moderate or severe ischemic MR, which was an independent risk factor affecting LVEF improvement in patients with ICM after PCI. Six months after discharge, the follow-up echocardiographic results showed that, regardless of LVEF improvement, 44.4% of patients with moderate or severe MR experienced a significant reduction in MR severity, suggesting that PCI can improve adverse ventricular remodeling in some patients with ICM.\u003c/p\u003e\n\u003cp\u003eThis study had some limitations. First, it was a single-center retrospective study, which inherently introduces selection bias and date absence. Second, the study group was relatively small. Third, this study only included patients who had echocardiographic results at 6 months after discharge. Compared with all patients with ICM who received PCI, the high rate of loss to follow-up may have impacted the results. Fourth, we did not follow on long-term events; thus, it was not possible to determine the association between improved ejection fraction and the occurrence of adverse events.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePrior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. Prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM. The adverse ventricular remodeling caused by ischemic factors negatively affected the improvement of cardiac function in patients with ICM. Standard drug therapy combined with PCI can reverse adverse ventricular remodeling in some patients and improve their cardiac function. However, the relationship between LVEF improvement after PCI in patients with ICM and clinical outcomes needs to be further confirmed by larger clinical studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate: This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University(2024-R218).\u003c/h4\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll the participants signed the written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the Second Hospital of Hebei Medical University, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Second Hospital of Hebei Medical University.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was supported by\u0026nbsp;Clinical Medical Talents Training Project Funded by Hebei Provincial Government, China\u0026nbsp;[ZF2023152].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eL.S., X.F., Y.W. and X.G. contributed to the conception and design of the work; L.S. drafted the manuscript; L.S., Y.J., Q.W., W.Z., Y.L. and Z.G. contributed to the acquisition, analysis, and interpretation of data; L.S., Y.W., Y.F., and X.G. critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.\u003c/p\u003e\n\u003ch4\u003eAcknowledgements:\u0026nbsp;Not applicable.\u003c/h4\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFelker GM, Shaw LK, O\u0026rsquo;Connor CM. A Standardized Definition of Ischemic Cardiomyopathy for Use in Clinical Research. J Am Coll Cardiol. 2002; 39: 210-218.\u003c/li\u003e\n \u003cli\u003eCabac-Pogorevici I, Muk B, Rustamova Y, Kalogeropoulos A, Tzeis S, Vardas P. Ischaemic cardiomyopathy. Pathophysiological insights, diagnostic management and the roles of revascularisation and device treatment. Gaps and dilemmas in the era of advanced technology. 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Functional significance of the discordance between transcriptional profile and left ventricular structure/function during reverse remodeling. JCI Insight. 2016; 1: e86038.\u003c/li\u003e\n \u003cli\u003eKramer DG, Trikalinos TA, Kent DM, Antonopoulos GV, Konstam MA, Udelson JE. Quantitative evaluation of drug or device effects on ventricular remodeling as predictors of therapeutic effects on mortality in patients with heart failure and reduced ejection fraction: a meta-analytic approach. J AM COLL CARDIOL. 2010; 56: 392-406.\u003c/li\u003e\n \u003cli\u003eSzymanski C, Levine RA, Tribouilloy C, Zheng H, Handschumacher MD, Tawakol A, et al. Impact of mitral regurgitation on exercise capacity and clinical outcomes in patients with ischemic left ventricular dysfunction. AM J CARDIOL. 2011; 108: 1714-1720.\u003c/li\u003e\n \u003cli\u003e.Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation. 2003; 108: 1713-1717.\u003c/li\u003e\n \u003cli\u003ePastorius CA, Henry TD, Harris KM. Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention. AM J CARDIOL. 2007; 100: 1218-1223.\u003c/li\u003e\n \u003cli\u003eDeja MA, Grayburn PA, Sun B, Rao V, She L, Krejca M, et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation. 2012; 125: 2639\u0026ndash;2648.\u003c/li\u003e\n \u003cli\u003eMichler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. NEW ENGL J MED. 2016; 374: 1932-1941.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Left ventricular ejection fraction improvement, Percutaneous coronary intervention, Ischemic cardiomyopathy","lastPublishedDoi":"10.21203/rs.3.rs-5167990/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5167990/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is a lack of relevant studies investigating left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) following percutaneous coronary intervention (PCI). This study aimed to investigate the factors influencing LVEF improvementafter PCI in patients with ICM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis single-center, retrospective study included consecutive patients diagnosed with ICM who underwent PCI at the Second Hospital of Hebei Medical University between January 2019 and March 2024. Patients were categorized into two groups based on changes in LVEF. The improved LVEF group included patients with ≥10% improvement, whereas the other group included patients who exhibited \u0026lt;10% improvement or deterioration. Clinical data were compared between the two groups. Univariate and multivariable logistic regression analyses were performed to assess factors affecting LVEF improvement, and nomogram prediction model for 6-month improvement in LVEF were developed based on logistic regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Overall, 123patients were enrolled in our study, with 52 patients showing ≥10% improvement and 71 patients showing \u0026lt;10% improvement or deterioration. Patients in the improved LVEF group were significantly more likely to have a lower prior myocardial infarction (MI), left ventricular end-diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV), and moderate or severe mitral regurgitation (MR) compared with the non-improved LVEF group. A nomogram predictive model was developed based on prior MI，LVEDD，LVEDV and moderate or severe MR, the AUC of the model is 0.734, indicating good discriminatory ability. The calibration curve and decision curve analysis show that the model has good consistency and clinical application value. Multivariable logistic regression analysis identified two independent factors for LVEF improvement: prior MI and moderate or severe MR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR were not conducive to LVEF improvement. The model based on prior MI, higher LVEDD, higher LVEDV, and moderate or severe MR have good predictive value for LVEF improvement. Prior MI and moderate or severe MR were independent risk factors for LVEF improvement in patients with ICM.\u003c/p\u003e","manuscriptTitle":"Analysis of risk factors and development of prediction model for improvement of ejection fraction in patients with ischemic cardiomyopathy after percutaneous coronary intervention: a case control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 16:50:43","doi":"10.21203/rs.3.rs-5167990/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc969bbc-b28a-4d2a-8c41-12a64868e866","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T13:25:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 16:50:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5167990","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5167990","identity":"rs-5167990","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}