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Prognostic importance of systolic and diastolic function after acute myocardial infarction
Jacob E Møller1, Kenneth Egstrup, Lars Køber
1Svendborg Hospital, Svendborg, Denmark. JEM@DADLNET.DC
Insights
Assessing left ventricular diastolic function, specifically mitral deceleration time and Tei index, provides crucial prognostic information after acute myocardial infarction (AMI). These measures are more predictive of outcomes than systolic function alone.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Research
Background:
- Standard acute myocardial infarction (AMI) risk stratification often prioritizes systolic left ventricular (LV) function.
- Comprehensive assessment including LV filling is valuable for risk stratification.
- Doppler echocardiography and the Tei index offer methods to evaluate LV filling and global function.
Purpose of the Study:
- To determine the prognostic significance of LV systolic, diastolic, and global function in a large AMI patient cohort.
- To evaluate the predictive value of echocardiographic parameters for all-cause mortality post-AMI.
Main Methods:
- Echocardiography performed within 6 days of AMI.
- Assessment of LV systolic function using wall motion index (WMI).
- Evaluation of LV diastolic function via mitral flow pattern and Tei index.
- Primary endpoint: all-cause death.
Main Results:
- In a multivariate model, restrictive filling (mitral deceleration time <140 ms) showed a significant association with increased mortality risk (RR 1.9).
- Higher Tei index values were strongly correlated with elevated risk of death (e.g., >0.68 associated with RR 4.0).
- In the presence of diastolic parameters, WMI lost its independent prognostic value.
Conclusions:
- Mitral deceleration time and Tei index are independent predictors of prognosis following AMI.
- Diastolic function assessment provides critical prognostic information beyond systolic function.
Background:
Although risk stratification after acute myocardial infarction (AMI) often is focused on systolic left ventricular (LV) function, it appears that a more complete study of ventricular function including assessment of LV filling would be useful. Doppler echocardiography allows assessment of LV filling, and with the use of the Tei index (sum of isovolumic relaxation and contraction times divided by ejection time), a global estimate of ventricular function may be obtained. Therefore, the aim of this study was to determine the prognostic importance of LV systolic, diastolic, and overall LV function in a large consecutive population with AMI.
Methods:
Echocardiography was performed within 6 days of AMI. LV systolic, diastolic, and global function was assessed by means of wall motion index (WMI), mitral flow pattern, and Tei index. The primary end point was all-cause death.
Results:
Of 799 enrolled patients, 197 died during a median follow-up of 34 months. In a multivariate model including WMI and clinical parameters, WMI had important prognostic information. When mitral filling pattern and quartiles of Tei index were added to the model, restrictive filling (mitral deceleration time <140 ms) was associated with a risk ratio of 1.9 (95% CI 1.3-2.7, P <.0001, Tei index values of >0.68/0.56-0.68/0.46-0.55/<0.46 were associated with risks of 4.0 [2.1-6.9]/2.3 [1.5-3.9]/2.1 [1.2-3.6]/1.0, P <.001). In this model, WMI had no prognostic value (P =.18).
Conclusions:
Mitral deceleration time and the Tei index have independent and important prognostic value after AMI.