Related Experiment Videos
Restrictive left ventricular filling pattern after myocardial infarction: significance of concomitant preserved
M I Burgess1, P Atkinson, S G Ray
1Department of Cardiology, Wythenshawe Hospital, Manchester, United Kingdom. MalcB10@aol.com
Insights
Restrictive left ventricular filling post-myocardial infarction (MI) is linked to systolic dysfunction. However, some patients with restrictive filling and preserved systolic function show a good prognosis, highlighting the need to assess both functions.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Restrictive left ventricular (LV) filling is a recognized high-risk indicator post-myocardial infarction (MI).
- The prognostic significance and extent of systolic dysfunction in patients with restrictive LV filling after MI remain unclear.
Purpose of the Study:
- To determine the incidence and extent of systolic dysfunction in post-MI patients with restrictive versus nonrestrictive LV filling.
- To examine the prognostic implications of restrictive LV filling and associated systolic function.
Main Methods:
- Doppler echocardiography was used to assess LV diastolic function in 102 post-MI patients within 4 days of infarction.
- Restrictive filling was defined by specific E:A ratio and deceleration time criteria.
- Patients were followed for a median of 11 months for heart failure development and mortality.
Main Results:
- Restrictive filling was identified in 19% of patients.
- Patients with restrictive filling were more likely to have systolic dysfunction (63% vs. 35%, P=0.024).
- Notably, 42% of patients with restrictive filling had preserved systolic function and a significantly better outcome (88% alive and HF-free vs. 36% with systolic dysfunction, P=0.026).
Conclusions:
- Restrictive LV filling post-MI can coexist with preserved systolic function, indicating a relatively favorable prognosis in these specific cases.
- Post-MI patients with restrictive filling represent a heterogeneous group.
- Comprehensive evaluation of both systolic and diastolic function is crucial for accurate risk stratification and management.
Abstract:
Restrictive left ventricular (LV) filling identifies a high risk subgroup, following myocardial infarction (MI). The extent and significance of systolic dysfunction in this group is not clear. The aim of our study was to determine the incidence and extent of systolic dysfunction in patients with restrictive filling and nonrestrictive filling examining the prognostic implications. Doppler parameters of LV diastolic function were measured in 102 post-MI subjects within 4 days. Restrictive filling was defined as the presence of E:A ratio > 2 or E:A ratio 1-2 with MDT < or = 140 msec. Follow-up was to a median of 11 months. Restrictive filling (group A) was found in 19 (19%) of 102 patients. Patients with this pattern were more likely to have systolic dysfunction than those without (group B); 63% and 35%, respectively, P = 0.024. Eight (42%) of 19 patients in group A had relatively preserved systolic function. At 11 months 14 patients had developed heart failure (HF), 6 in group A (32%) and 8 in group B (10%), P = 0.012. There were two deaths (11%) in group A and 7 (8%) in group B, P = ns. Seven (88%) of 8 patients in group A with relatively preserved systolic function were alive and free of heart failure at follow-up compared to 4 of 11 patients (36%) in group A with systolic dysfunction (P = 0.026). Restrictive filling can be associated with relatively preserved systolic function after MI and these patients have a relatively good outcome. Patients with restrictive filling post-MI are a heterogeneous group emphasizing the evaluation of both systolic and diastolic function.