Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first
J E Møller1, E Søndergaard, S H Poulsen
1Department of Medicine, Svendborg Hospital, Denmark. jam@shf.fyns-amt.dk
Insights
Abnormal left ventricular (LV) filling patterns, specifically pseudonormal or restrictive filling, after a first myocardial infarction (MI) predict cardiac death. These patterns are also linked to progressive LV dilation, highlighting their prognostic significance.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Left ventricular (LV) filling patterns, assessed by mitral E-wave deceleration time (DT) and flow propagation velocity (Vp), help differentiate LV filling abnormalities after myocardial infarction (MI).
- Abnormal LV filling is common post-MI, and combined DT and Vp assessment can identify pseudonormal filling, which may have prognostic implications.
Purpose of the Study:
- To evaluate the prognostic value of LV filling patterns (DT and Vp) for cardiac death and LV volume changes after a first MI.
- To determine if specific LV filling patterns predict outcomes in post-MI patients.
Main Methods:
- Echocardiography was performed at 24 hours, 5 days, 1 month, and 3 months post-MI in 125 patients.
- LV filling patterns were classified as normal, impaired relaxation, pseudonormal, or restrictive based on DT and Vp values.
- Cox analysis was used to identify independent predictors of cardiac death.
Main Results:
- Patients with pseudonormal or restrictive filling showed significantly increased LV end-systolic and end-diastolic volumes.
- Mortality was significantly higher in patients with impaired relaxation, pseudonormal, or restrictive filling compared to normal filling.
- Restrictive filling, pseudonormal filling, and Killip class > or =II independently predicted cardiac death.
Conclusions:
- Pseudonormal and restrictive LV filling patterns are associated with progressive LV dilation after a first MI.
- These abnormal LV filling patterns are significant independent predictors of cardiac death in the post-MI setting.
Objectives:
We sought to assess the prognostic value of left ventricular (LV) filling patterns, as determined by mitral E-wave deceleration time (DT) and color M-mode flow propagation velocity (Vp), on cardiac death and serial changes in LV volumes after a first myocardial infarction (MI).
Background:
Combined assessment of DT and Vp allows separation of the effects of compliance and relaxation on LV filling, thereby allowing identification of pseudonormal filling. This may be valuable after MI, where abnormal LV filling is frequently present.
Methods:
Echocardiography was performed within 24 h, five days and one and three months after MI in 125 unselected consecutive patients. Normal filling was defined as DT 140 to 240 ms and Vp > or =45 cm/s; impaired relaxation as DT > or =240 ms; pseudonormal filling as DT 140 to 240 ms and Vp <45 cm/s; and restrictive filling as DT <140 ms.
Results:
Left ventricular filling was normal in 38 patients; impaired relaxation in 38; pseudonormal in 23; and restrictive in 26. End-systolic and end-diastolic volume indexes were significantly increased during the first three months after MI in patients with pseudonormal or restrictive filling (37+/-15 vs. 47+/-19 ml/m2, p<0.0005 and 71+/-20 vs. 88+/-24 ml/m2, p<0.0005, respectively). During a follow-up period of 12+/-7 months, 33 patients died. Mortality was significantly higher in patients with impaired relaxation (p = 0.02), pseudonormal filling (p<0.00005) and restrictive filling (p<0.00005), compared with patients with normal filling. On Cox analysis, restrictive filling (p = 0.003), pseudonormal filling (p = 0.006) and Killip class > or =II (p = 0.008) independently predicted cardiac death, compared with clinical and echocardiographic variables.
Conclusions:
Pseudonormal or restrictive filling patterns are related to progressive LV dilation and predict cardiac death after a first MI.
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