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Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute
S H Poulsen1, J E Møller, B Nørager
1Section of Cardiology, Department of Medicine, Haderslev Hospital, Haderslev, Denmark. steen.hvitfeldt@dadlnet.dk
Insights
Diastolic dysfunction in myocardial infarction (MI) patients with preserved left ventricular (LV) systolic function significantly increases cardiac mortality. Early detection of diastolic dysfunction is crucial for managing MI patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- The role of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function after myocardial infarction (MI) remains unclear.
- Understanding its impact on functional status and mortality is critical for patient outcomes.
Purpose of the Study:
- To investigate the contribution of diastolic dysfunction to impaired functional status and cardiac mortality in patients with preserved LV systolic function following acute MI.
- To identify predictors of adverse events in this patient population.
Main Methods:
- Doppler analysis of mitral and pulmonary venous flow, and color M-mode Doppler echocardiography were used to assess LV diastolic function.
- 183 consecutive patients were classified into four groups based on LV systolic and diastolic function post-MI.
Main Results:
- Cardiac mortality at 1 year was significantly higher in patients with LV diastolic dysfunction (13% in Group C, 38% in Group D) compared to those with preserved diastolic function (2% in Group A).
- Multivariate analysis identified LV diastolic dysfunction, Killip class >or=II, and age as independent predictors of cardiac death or heart failure readmission.
Conclusions:
- LV diastolic dysfunction, even with preserved systolic function, is associated with increased morbidity and mortality after acute MI.
- These findings highlight the importance of evaluating diastolic function in MI patients for risk stratification and management.
Abstract:
The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73); group B: LV systolic dysfunction with preserved diastolic function (n = 10); group C: LV diastolic dysfunction with preserved systolic function (n = 60); group D: combined LV systolic and diastolic dysfunction (n = 40). The cardiac mortality rate at 1 year was significantly higher in groups C (13%) and D (38%) compared to A (2%) (p < 0.01). Multivariate regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved systolic dysfunction is associated with increased morbidity and mortality following acute MI.